Kidney-placenta crosstalk in health and disease

Organ crosstalk allows the interaction between systems to adapt to a constant changing environment, maintaining homeostasis. The process of placentation and the new hormonal environment during pregnancy trigger physiological changes that modulate kidney function to control extracellular volume, acid-base balance and filtration of metabolic waste products. The bidirectional communication means that acute or chronic dysfunction of one organ can compromise the other. Abnormal placentation in pregnancy-related hypertensive disorders such as pre-eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome leads to the release of antiangiogenic factors that may cause kidney injury (thrombotic microangiopathy, glomeruloendotheliosis, mesangiolysis and vasoconstriction of peritubular vessels). These hypertensive disorders are a key cause of kidney injury in gestation, which increases maternal morbimortality and adverse foetal outcomes. Conversely, prior kidney injury or causes of kidney injury (diabetes, lupus, glomerulonephritis or other forms of chronic kidney disease) increase the risk of developing hypertensive pregnancy disorders, providing a baseline higher risk. Inherited kidney diseases are a special concern, given the potential for genetic predisposition to kidney disease in the foetus. Understanding the bidirectional potential for compromise from placenta to kidney and vice versa provides a better framework to limit damage to both organs and improve maternal and foetal outcomes.

Automated summary

Organ crosstalk is crucial for maintaining homeostasis and adapting to a changing environment. During pregnancy, the process of placentation and hormonal changes can impact kidney function, leading to potential kidney injury. Hypertensive disorders in pregnancy, such as pre-eclampsia and HELLP syndrome, can cause abnormal placentation and release of antiangiogenic factors, further increasing the risk of kidney damage. Conversely, pre-existing kidney injury or chronic kidney diseases can increase the likelihood of developing hypertensive pregnancy disorders. Understanding the bidirectional relationship between the placenta and the kidneys is important for minimizing organ damage and improving maternal and fetal outcomes.