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J Am Soc Nephrol ; 27(3): 903-13, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26405111

RESUMEN

Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasma-specific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, new onset protein/creatinine ratio >0.30 g/g, and sFlt-1/placental growth factor ratio >85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings.


Asunto(s)
Peso al Nacer , Eliminación de Componentes Sanguíneos/métodos , Sulfato de Dextran/uso terapéutico , Preeclampsia/terapia , Receptor 1 de Factores de Crecimiento Endotelial Vascular/sangre , Adulto , Eliminación de Componentes Sanguíneos/efectos adversos , Presión Sanguínea , Sulfato de Dextran/química , Femenino , Edad Gestacional , Frecuencia Cardíaca Fetal , Humanos , Recién Nacido , Terapia por Inhalación de Oxígeno , Proyectos Piloto , Preeclampsia/sangre , Embarazo , Mantenimiento del Embarazo , Nacimiento Prematuro/prevención & control , Proteinuria/terapia , Receptor 1 de Factores de Crecimiento Endotelial Vascular/química , Adulto Joven
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