ABSTRACT
BACKGROUND: The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. METHODS: Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. RESULTS: Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. CONCLUSION: GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Acute Kidney Injury , Cohort Studies , Cooperative Behavior , Creatinine , Cystatin C , Diet , Epidemiology , Gestational Age , Glomerular Filtration Rate , Infant, Low Birth Weight , Kidney , Obstetric Labor, Premature , Pre-Eclampsia , Renal Insufficiency, Chronic , ROC Curve , Sensitivity and SpecificityABSTRACT
Endometriosis is an estrogen dependent disorder that needs long term treatment. The primary goal of treatment is to alter the growth and activity of endometriotic lesions by inhibiting ovulation and/or inducing atrophic endometrium. Increasing knowledge of the pathogenesis of endometriosis at the molecular and cellular levels has given the opportunity to develop new therapeutic agents. Which have greater efficacy and flexibility than traditional treatments. The new agents are classified as anti-estrogen, anti-progesterone, angiogenesis inhibitors, immunomodulating agents and anti-inflammatory drugs. This review focuses on the new experimental approaches to the medical treatment of pelvic endometriosis.
ABSTRACT
Pelvic endometriosis is a frequently encountered gynecologic disorder in female patients. It is the leading cause of pelvic pain and infertility. Pelvic endometriosis is classified into 3 groups according to its gross pathology as follow, pelvic peritoneal endometriosis, ovarian endometrioma and rectovaginal nodule. Differential diagnosis from other diseases can be performed by laboratory studies, imaging studies and laparoscopy. The treatments of this condition compose of medical and surgical treatment. At present, various medical therapies are available. However, the mainstay for long term treatment is hormonal suppression agents. The current medical management of pelvic endometriosis is reviewed in this article.