1. Raj Kiran Medapalli, MD, MPH. Nephrology Fellow October 1st, 2008 Mount Sinai School of Medicine Division of Nephrology Journal Club

2. Preeclampsia and the Risk of ESRD Vikse et al. N Engl J Med. 2008 Aug 21;359(8):800-9.

6. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Duckitt K and Harrington D. BMJ. 2005 Mar 12;330(7491):565. (38 cohort studies published between 1966 and 2002)

14. Suggested Pathophysiology of Preeclampsia Reference: Parikh, SM & Karumanchi, SA. Putting Pressure on Pre-eclampsia. Nat Med 14 (8), 810-812 (2008)

15. Glomerular Endotheliosis Swelling of damaged endothelial cells, leads to partial closure of many of the capillary lumens (large arrows). Mitosis within an endothelial cell (small arrow) is a sign of cellular repair.

17. Preeclampsia and risk of HTN Reference: Bellamy et al. Pre-eclampsia and risk of cardiovascular disease and cancer later in life: systematic review and metaanalysis. BMJ 2007;335;974.

18. Preeclampsia and risk of CVD Reference: Bellamy et al. Pre-eclampsia and risk of cardiovascular disease and cancer later in life: sytematic review and metaanalysis. BMJ 2007;335;974.

19. Preeclampsia and risk of Stroke and DVT. Reference: Bellamy et al. Pre-eclampsia and risk of cardiovascular disease and cancer later in life: sytematic review and metaanalysis. BMJ 2007;335;974.

21. Preeclampsia and long term mortality Reference: Irgens et al. Long term mortality of mothers and fathers after preeclampsia: population based cohort study. BMJ. 2001 Nov 24;323(7323):1213-7 .

22. Preeclampsia and long term mortality Reference: Irgens et al. Long term mortality of mothers and fathers after preeclampsia: population based cohort study. BMJ. 2001 Nov 24;323(7323):1213-7 .

24. Persistent Endothelial Dysfunction 5-6 yrs after Preeclampsia Reference: Chambers et al. Association of maternal endothelial dysfunction with preeclampsia. JAMA. 2001 Mar 28;285(12):1607-12.

26. Persistant microalbuminuria after preeclampsia Reference: Bar et al. Microalbuminuria after pregnancy complicaed by preeclampsia. Nephrol Dial Transplant (1999) 14:1129-1132.

28. Preeclampsia and risk of having a kidney biopsy later in life Reference: Vikse et al. Adverse perinatal outcome and later kidney biopsy in the mother. J Am Soc Nephrol. 2006 Mar;17(3):837-45.

29. Preeclampsia and risk of having a kidney biopsy later in life Reference: Vikse et al. Adverse perinatal outcome and later kidney biopsy in the mother. J Am Soc Nephrol. 2006 Mar;17(3):837-45.

30. Preeclampsia and the Risk of ESRD Vikse et al. N Engl J Med. 2008 Aug 21;359(8):800-9.

40. 1980 1973 1970 1967 2005 P#1 P#2 3 yrs 7 yrs 25 yrs 1980 1973 1970 1967 1990 2005 P#1 P#2 ESRD/Death 3 yrs 7 yrs 10 yrs Example 1 : No ESRD or Death during the study period (1967 to 2005) Total Time included in the study = 7 + 25 = 32 years Example 2: ESRD or Death in 1990 Total time included in the study: 7 + 10 = 17 years

41. 1980 1973 1970 1967 2005 P#1 P#2 1980 1973 1970 1967 1976 2005 P#1 P#2 Death Example 3 : ESRD in 1976 Total Time included in the study =??? It is not clear if this patient would be registered in the Renal Registry or not. Example 4: Death in 1976 Total time included in the study: ??? Authors did not specify in the methods section how they dealt with these pts 1976 ESRD

45. Cumulative risk of ESRD