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| Item Type: | Book Section |
|---|---|
| Title: | The renin-angiotensin system, its autoantibodies, and body fluid volume in preeclampsia |
| Creators Name: | Dechend, R., Lamarca, B. and Taylor, R.N. |
| Abstract: | This chapter reviews physiological changes in volume and osmolality in normal pregnancy, as well as alterations in volume and related humoral systems associated with preeclampsia. There is a ~12 kg weight gain, associated with 30–50% increases in extracellular fluid, plasma, blood volume and total body water plus a resetting of the thresholds for vasopressin secretion and thirst, plasma osmolality averaging 10 mosmol below nonpregnant levels. There is a marked stimulation of the RAA system and other potent mineralocorticoids that accompany these changes, while opposing these salt-retaining influences are increases in GFR and a rise in the plasma concentration of several natriuretic hormones. There is ongoing debate concerning the cause and meaning of the increased plasma volume (does it represent “under-fill,” “over-fill,” or “normal-fill”?) and resolving this debate has implications for management of complications. Plasma volume decreases in preeclampsia (most marked in eclampsia), while the interstitial water may increase further (edema) or remain unchanged. Levels of all components of the RAA system are decreased compared to normal pregnancy. There is an evolving literature on the role of the dilating peptide Ang 1–7 in normal pregnancy and preeclampsia. Finally, current thoughts regarding treating preeclampsia with sodium loading or plasma volume expansion, a controversial area, were revisited in light of the recent discovery of genetic mutations leading to inefficient aldosterone production in preeclampsia. Contrarily, the possible presence of ouabain-like factors in animal models and women with preeclampsia was also noted. |
| Keywords: | Animals, Mice, Rats |
| Source: | Chesley's Hypertensive Disorders in Pregnancy |
| Title of Book: | Chesley's Hypertensive Disorders in Pregnancy (Fourth Edition) |
| ISBN: | 978-0-12-407866-6 |
| Publisher: | Academic Press |
| Page Range: | 315-334 |
| Number of Pages: | 489 |
| Date: | 2015 |
| Official Publication: | https://doi.org/10.1016/B978-0-12-407866-6.00015-8 |
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