Role of calcitriol in modulating of placental dysfunction in pregnant women with chronic kidney disease

The pleiotropic effects of vitamin D (VD), whose active form is synthesized in the kidneys, play a certain role both in forming and functioning the feto-placental system, including various pregnancy complications. The aim of the study was to evaluate the vitamin D status in pregnant women with placental dysfunction (PD) and chronic inflammatory kidney disease (CIKD). During 24–34 pregnancy weeks, 56 pregnant women with PD were examined (main group ‒ I); 24 patients (42.85 %) had chronic pyelonephritis (group IA). The control group (group II) had 31 conditionally healthy pregnant women. The total VD level in the blood was determined by ELISA; in addition to the general clinical standard examination, the urine also underwent bacteriological examination. The VD mean level in pregnant women with PD and CIKD was significantly lower than that in the control group (31.08 ± 7.2 and 45.42 ± 9.67 ng/ml (p <0.01)). Only 33.33 % of pregnant women in group IA had a VD optimum, as well as 93.55 % (p < 0.01) in the control group and 17.86 % in group I. 8.33 % of pregnant women had a VD deficiency in group IA (RR = 2.09; CI 95 % ‒ 1.8‒2.42). The patients with a VD-deficiency were absent in the control group. 58.33 % of women in group ІА had a suboptimal VD level and 6.45% in the control group (RR = 3.57; CI 95 % ‒ 1.62‒7.88). Bacteriuria was observed in all pregnant women with a VD-deficient or suboptimal level. At the optimum VD level, bacteriuria was diagnosed twice less (χ² = 66.67; p <0.01). In patients with an inadequate VD level, CIKD was diagnosed 3.8 times more (RR = 3.57; CI 95 % ‒ 1.62‒7.88). 494 Proceedings of the National Academy of Sciences of Belarus. Medical series, 2020, vol. 17, no. 4, pp. 493–499 A significantly calcitriol reduction in pregnant women with placental dysfunction suggests that the deficiency or the suboptimal level of vitamin D and inflammatory kidney diseases may be the interdependent processes that play a decisive role in the formation of placental dysfunction.

1. Gilbert N. M., O’brien V. P., Hultgren S., Macones G., Lewis W. G., Lewis A. L. Urinary tract infection as a preventable cause of pregnancy complications: opportunities, challenges, and a global call to action. Global Advances in Health and Medicine, 2013, vol. 2, no. 5, pp. 59‒69. https://doi.org/10.7453/gahmj.2013.061

2. Kaptil’nyi V. A. Infection of the urinary tract during pregnancy. Arkhiv akusherstva i ginekologii imeni V. F. Snegireva [Archive of obstetrics and gynecology named after V. F. Snegireva], 2015, no. 4, pp. 10‒19 (in Russian).

3. Peresada O. A. Infections of the urinary tract in pregnant women: modern approaches to the diagnosis and treatment. Meditsinskie novosti [Medical news], 2012, no. 8, pp. 13–20 (in Russian).

4. Egorova Ya. A., Zabolotnov V. A., Rybalka A. N. Delay in fetal development in perinatal medicine (review). Zdorov’e zhenshchiny [Women’s health], 2015, no. 4 (100), pp. 48‒51 (in Russian).

5. Kalinchenko S. Yu., Zhilenko M. I., Gusakova D. A., Tyuzikov R., Mskhalaya G. Zh., Sablin K. S., Dymova A. V. Vitamin D and women’s reproductive health. Problemy reproduktsii [Problems of reproduction], 2016, vol. 22, no. 4, pp. 28–36 (in Russian).

6. Javorski N., Lima C. A. D., Silva L. V. C., Crovella S., de Silva J. A. Vitamin D receptor (VDR) polymorphisms are associated to spontaneous preterm birth and maternal aspects. Gene, 2018, vol. 642, pp. 58‒63. https://doi.org/10.1016/j.gene.2017.10.087

7. Merhi Z., Doswell A., Krebs K., Cipolla M. Vitamin D alters genes involved in follicular development and steroidogenesis in human cumulus granulosa cells. Journal of Clinical Endocrinology and Metabolism, 2014, vol. 99, no. 6, pp. 1137–1145. https://doi.org/10.1210/jc.2013-4161

8. Mal’tseva L. I., Vasil’eva E. N., Denisova T. G. Vitamin D and preeclampsia. Rossiiskii vestnik akushera-ginekologa [Russian bulletin of the obstetrician-gynecologist], 2016, vol. 16, no. 1, pp. 79–83 (in Russian).

9. Mal’tsev S. V., Mansurova G. Sh. Vitamin D metabolism and ways to implement its main functions. Prakticheskaya meditsina [Practical medicine], 2014, no. 9 (85), pp. 12‒18 (in Russian).

10. Mikhailova N. A. Selective activator of vitamin D receptors paricalcitol and its place in the treatment of chronic kidney disease. Literature review. Lechashchii vrach [Attending doctor], 2011, no. 2, p. 82 (in Russian).

11. Shalaby S. A., Handoka N. M., Amin R. E. Vitamin D deficiency is associated with urinary tract infection in children. Archives of Medical Sciences, 2018, vol. 14, no. 1, pp. 115‒121. https://doi.org/10.5114/aoms.2016.63262

12. Nseir W., Taha M., Nemarny H., Mograbi J. The association between serum levels of vitamin D and recurrent urinary tract infections in premenopausal women. International Journal of Infectious Diseases, 2013, vol. 17, no. 12, pp. e1121–e1124. https://doi.org/10.1016/j.ijid.2013.06.007

13. Gordovskaya N. B., Korotchaeva Yu. V. Asymptomatic bacteriuria in pregnant women: diagnosis and treatment. Al’manakh klinicheskoi meditsiny [Clinical medicine almanac], 2014, no. 30, pp. 57‒60 (in Russian).

14. Ramos N. L., Sekikubo M., Kironde F., Mirembe F., Sääf M., Brauner A. The impact of vitamin D on the innate immune response to uropathogenic Escherichia coli during pregnancy. Clinical Microbiology and Infection, 2015, vol. 21, no. 5, pp. 482.e1‒482.e7. https://doi.org/10.1016/j.cmi.2014.12.010

15. Barrera D., Díaz L., Noyola-Martínez N., Halhali A. Vitamin D and inflammatory cytokines in healthy and preeclamptic pregnancies. Nutrients, 2015, vol. 7, no. 8, pp. 6465‒6490. https://doi.org/10.3390/nu7085293

16. Cantorna M. T., Snyder L., Lin Y. D., Yang L. Vitamin D and 1.25 (OH) 2D regulation of T cells. Nutrients, 2015, vol. 7, no. 4, pp. 3011‒3021. https://doi.org/10.3390/nu7043011

17. Lokshin K. L. Actual issues of diagnosis and treatment of asymptomatic bacteriuria and acute cystitis in pregnant women. Effektivnaya farmakoterapiya. Urologiya i nefrologiya [Effective pharmacotherapy. Urology and nephrology], 2014, no. 3 (32), pp. 22‒26 (in Russian).

18. Kikuta J., Ishii M. Current topics on vitamin D. The effects of vitamin D on the immune system. Clinical Calcium, 2015, vol. 25, no. 3, pp. 359‒365 (in Japanese).