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The Dynamics of Glomerular Filtration after Caesarean Section

RICHARD A. LAFAYETTE^*, TAHIRA MALIK^*, MAURICE DRUZIN, GERALDINE DERBY^* and BRYAN D. MYERS^*

^* Department of Medicine, Stanford University Medical Center, Stanford University School of Medicine, Stanford, California.
Department of Obstetrics, Stanford University Medical Center, Stanford University School of Medicine, Stanford, California.

Correspondence to Dr. Richard A. Lafayette, Division of Nephrology, Stanford University Medical Center, Stanford, CA 94305-5114. Phone: 650-723-6247; Fax: 650-723-7917; E-mail: czar{at}leland.stanford.edu

Abstract. The objective of this study was to determine whether the glomerular hyperfiltration of pregnancy is maintained even after Caesarean section and, if so, to define the responsible hemodynamics. The dynamics of glomerular filtration were evaluated in 12 healthy women who had just completed an uncomplicated pregnancy and were delivered by Caesarean section. Age-matched but non-gravid female volunteers (n = 22) served as control subjects. GFR in postpartum women was elevated above control values by 41%; 149 ± 10 versus 106 ± 3 ml/min per 1.73 m², respectively (P < 0.001). In contrast, corresponding renal plasma flow was the same in the two groups, such that the postpartum filtration fraction was significantly elevated by 20%. Computation of glomerular intracapillary oncotic pressure (_GC) from knowledge of plasma oncotic pressure and the filtration fraction revealed this quantity to be significantly reduced in postpartum women, 20.6 ± 1.7 versus 26.1 ± 2.0 mmHg in control subjects (P < 0.001). A theoretical analysis of glomerular ultrafiltration suggests that depression of _GC, the force opposing the formation of filtrate, is predominantly or uniquely responsible for the observed postpartum hyperfiltration.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673