Pleiotropic effects of vitamin D in an early stage of chronic kidney disease—effect on insulin resistance

888, 667 and 123 pg/mL. Conversely, serum creatinine and uric acid remained unchanged, 30 days after delivery at 141 and 428 μmol/L, respectively. Comment. This case illustrates the difficulty in differentiating a superimposed pre-eclampsia from an isolated deterioration of a pre-existing renal disease during pregnancy. The increase in serum uric acid can be explained by a superimposed pre-eclampsia or by the impact of pregnancy in worsening pre-existing nephropathy, similar to the onset of hypertension. The high levels of circulating sFlt-1 found before delivery were in the same range as the mean serum level of 4382 pg/mL found by Levine et al. in the group of women with pre-eclampsia at a similar gestational age (as compared with 1643 pg/mL, in the control group of women with normal pregnancy) and strongly suggests an excess placental production related with superimposed pre-eclampsia [2,3]. Because of the possibility of falsepositive values, histological placenta data would have been better to confirm the diagnosis [4]. Unfortunately, the latter was not preserved. However, these high levels of circulating sFlt-1 cannot account for the concomitant renal dysfunction. Indeed, renal failure is usually associated with a significant, but very moderate, increase in circulating sFlt-1 [5]. Moreover, in the present case, circulating levels of sFlt-1 fall rapidly after delivery despite the persistence of renal failure and hyperuricaemia. Variations of sFlt-1-circulating levels have been mainly studied among population groups of gestational women. The present case demonstrates that the results of several sFlt-1-circulating assays performed on the same patient can also assist better birth management in difficult situations.