Figure 2.

Endothelial dysfunction in CKD means that the clinical syndrome of preeclampsia can manifest with less angiogenic dysregulation, compared with women without CKD. Physiologic changes in angiogenesis at the end of pregnancy trigger delivery, but do not manifest as clinical preeclampsia in women without CKD (blue line). Women with CKD can manifest preeclampsia without significant angiogenic dysfunction (red line) because endothelial dysfunction owing to CKD places them closer to the threshold for clinical disease. Women with and without CKD who have an abnormal placenta resulting in pathologic angiogenic dysfunction (dashed lines) can both develop pregnancy-related disease (preeclampsia or fetal growth restriction). Women without CKD who develop preeclampsia are more likely to have cardiovascular and kidney disease later in life. Modified from reference 74, with permission.