Renal functional reserve in pregnancy

Abstract

Creatinine clearance has been evaluated under baseline conditions and after acute protein load in five normal and 29 pregnant women at different stages of pregnancy without evidence of renal disease. After a 3-h period in which creatinine clearance was measured hourly (resting GFR), a meal containing 80 g of proteins was administered and creatinine clearance was measured hourly for 4 h (test GFR). Resting GFR in normal subjects averaged 104 +/- 22.5 ml/min per 1.73 m2, the wide variation being due to different dietary, protein intake (from 0.3 to 1.2 g of protein per kg body weight). In the pregnant women the resting GFR increased progressively from the first month (99.8 +/- 12.8 ml/min per 1.73 m2) to the last month of gestation (149.6 +/- 12.5 ml/min per 1.73 m2). All subjects showed a significant increase of GFR after protein load although the greatest difference between the resting and the test GFR was detected in the first trimester. Inulin clearance was also measured in seven subjects after protein loading to compare creatinine and inulin clearance values. The two clearance values did not differ significantly, showing that creatinine can be safely used as a reliable marker for measuring GFR. Test GFR averaged 163.3 +/- 4.1 ml/min per 1.73 in normal subjects and 163.8 +/- 6.5 ml/min per 1.73 m2 in pregnant women without any relationship with the stage of pregnancy. The identity of test GFR both in normal subjects and in pregnant women suggests that this parameter is likely to be related to the functioning renal mass, and represents the filtration capacity of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)