Scholarly record
PREGNANCY AND CKD: ALWAYS A CHALLENGE!
Abstract
Pregnancy associated with chronic kidney disease (CKD) have a significant fetal and maternal risk, including developing preeclampsia, prematurity and progress of renal function. Is CKD a barrier in conception? The aim of the study was to monitor the maternal and fetal evolution and complications occurring during pregnant patients with different degrees of CKD. Our study used a descriptive and prospective plan for analyzing pregnancies of women with CKD and the fetal and maternal impact of it. A total of 23 patients were included in the study and were followed for three years. Results: Of total number of 104 patients with renal pathology included in studied group, 23 had chronic kidney disease (22%) and the rest of it had acute renal insufficiency or infectious renal pathology. Depending on the evolution of CKD there were 8 cases with acute deterioration of renal function and 15 cases in which the renal function remained stationary. The underlying renal disease was represented by autosomal dominant polycystic kidney disease, diabetic nephropathy, chronic pyelonephritis, glomerular nephropathies, and women who have already been on hemodialysis therapy. Urinary tracinfections, nephrotic syndrome and preeclampsia were the main causes of acute on CKD. Complications were represented by spontaneous abortions, prematurity, septic shock and, in some cases, followed by progression of CKD stage. Conclusions: Pregnancy associated with CKD represents a challenge for physicians, even in early stages, and it is necessary to be monitored in a multidisciplinary team, for reducing fetal and maternal risks.
Publication Impact Profile
- Captures
- Mendeley - Readers: 4
Publication details
References44
P. Jungers, D. Forget, H. Skhiri, I. Giatras, M. Labrunie, and B. DescampsLatscha, �Influence of pregnancy on the course of primary chronic glomerulonephritis,� The Lancet, vol. 346, no. 8983, pp. 1122�1124, Oct. 1995, DOI: 10.1016/S0140-6736(95)91798-5.
S. Hou, �Pregnancy in chronic renal insufficiency and end-stage renal disease,� American Journal of Kidney Diseases, vol. 33, no. 2, pp. 235�252, 1999, DOI: 10.1016/S0272-6386(99)70296-9.
C. L. Sanders and M. J. Lucas, �Renal disease in pregnancy,� Obstetrics and Gynecology Clinics of North America, vol. 28, no. 3, pp. 593�600, 2001, DOI: 10.1016/S0889-8545(05)70220-5.
E. Imbasciati Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P. � Pregnancy in CKD Stages 3 to 5: Fetal and Maternal Outcomes,� American Journal of Kidney Diseases, vol. 49, no. 6, pp. 753�762, Jun. 2007, DOI: 10.1053/j.ajkd.2007.03.022.
A. Smyth, M. Radovic, and V. D. Garovic, �Women, kidney disease, and pregnancy,� Advances in Chronic Kidney Disease, vol. 20, no. 5. NIH Public Access, pp. 402�410, Sep. 2013, DOI: 10.1053/j.ackd.2013.06.004.
A. D. Kaze, T. Ilori, B. G. Jaar, and J. B. Echouffo-Tcheugui, �Burden of chronic kidney disease on the African continent: A systematic review and meta-analysis,� BMC Nephrology, vol. 19, no. 1. BioMed Central Ltd., Jun. 01, 2018, DOI: 10.1186/s12882- 018-0930-5. 018-0930-5
H. N. Gouda Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, Leung J, Santamauro D, Lund C, Aminde LN, Mayosi BM, Kengne AP, Harris M, Achoki T, Wiysonge CS, Stein DJ, Whiteford H. Burden of non-communicable diseases in sub-Saharan Africa, 1990�2017: results from the Global Burden of Disease Study 2017,� The Lancet Global Health, vol. 7, no. 10, pp. e1375�e1387, Oct. 2019, DOI: 10.1016/S2214-109X(19)30374-2.
R. Peck Baisley K, Kavische B, Were J, Mghamba J, Smeeth L, Grosskurth H, Kapiga S,, �Decreased renal function and associated factors in cities, towns and rural areas of Tanzania: A community-based population survey,� Tropical Medicine and International Health, vol. 21, no. 3, pp. 393�404, Mar. 2016, DOI: 10.1111/tmi.12651.
F. I. Conti-Ramsden Hannah L., Annemarie De greeff,David R Hall, Paul T. Seed, Lucy C. Chappel, Andrew H. Shennan, K. Braham., �Pregnancy-related acute kidney injury in preeclampsia: Risk factors and renal outcomes,� Hypertension, vol. 74, no. 5, pp. 1144�1151, Nov. 2019, DOI: 10.1161/HYPERTENSIONAHA.119.13089.
J. W. Stanifer, Turner E.L., Egger J.R., Thielman N., Karia F., Maro, V. Kilonzo, K. Patel, U. D., Yeates K., �Knowledge, attitudes, and practices associated with chronic kidney disease in northern Tanzania: A community-based study,� PLoS ONE, vol. 11, no. 6, Jun. 2016, DOI: 10.1371/journal.pone.0156336.
R. Bakker, E. A. P. Steegers, A. Hofman, and V. W. V. Jaddoe, �Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes,� American Journal of Epidemiology, vol. 174, no. 7, pp. 797�806, Oct. 2011, DOI: 10.1093/aje/kwr151.
M. Petri, �Systemic lupus erythematosus and pregnancy,� Rheumatic Disease Clinics of North America, vol. 20, no. 1. NIH Public Access, pp. 87�118, 1994, Accessed: Apr. 04, 2021. [Online]. Available: /pmc/articles/PMC5288842/. DOI: 10.1016/S0889-857X(21)00227-1
M. E. B. Clowse, M. Jamison, E. Myers, and A. H. James, �A national study of the complications of lupus in pregnancy,� American Journal of Obstetrics and Gynecology, vol. 199, no. 2, pp. 127.e1-127.e6, 2008, DOI: 10.1016/j.ajog.2008.03.012.
J. Ritchie, A. Smyth, C. Tower, M. Helbert, M. Venning, and V. D. Garovic, �Maternal deaths in women with lupus nephritis: A review of published evidence,� Lupus, vol. 21, no. 5, pp. 534�541, Apr. 2012, DOI: 10.1177/0961203311434939.
S. J. Wagner, Craici I, Reed D, Norby S, Bailey K, Wiste HJ, Wood CM, Moder KG, Liang KP, Liang KV, Rose C, Rozkos T, Sitina M, Grande JP, Garovic VD�Maternal and foetal outcomes in pregnant patients with active lupus nephritis,� Lupus, vol. 18, no. 4, pp. 342�347, 2009, DOI: 10.1177/0961203308097575.
E. E. Lee, J. K. Jun, and E. B. Lee, �Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy,� Journal of Korean Medical Science, vol. 36, no. 4, pp. 1�11, Jan. 2021, DOI: 10.3346/jkms.2021.36.e24.
M. L. Gonzalez Suarez, A. Kattah, J. P. Grande, and V. Garovic, �Renal Disorders in Pregnancy: Core Curriculum 2019,� American Journal of Kidney Diseases, vol. 73, no. 1. W.B. Saunders, pp. 119�130, Jan. 01, 2019, DOI: 10.1053/j.ajkd.2018.06.006.
T. J. Stanhope, W. M. White, K. G. Moder, A. Smyth, and V. D. Garovic, �Obstetric nephrology: lupus and lupus nephritis in pregnancy.,� Clinical journal of the American Society of Nephrology�: CJASN, vol. 7, no. 12. Clin J Am Soc Nephrol, pp. 2089�2099, 2012, DOI: 10.2215/CJN.12441211.
Kincad-Smith P and Fairley KF, �Renal disease in pregnancy. Three controversial areas: mesangial IgA nephropathy, focal glomerular sclerosis (focal and segmental hyalinosis and sclerosis), and reflux nephropathy,� American journal of kidney diseases�: the official journal of the National Kidney Foundation, vol. 9, no. 4, pp. 328� 333, 1987, DOI: 10.1016/S0272-6386(87)80131-2.
S. Abe, �The influence of pregnancy on the long-term renal prognosis of IgA nephropathy,� Clinical Nephrology, vol. 41, no. 2, pp. 61�64, Feb. 1994, Accessed: Apr. 04, 2021. [Online]. Available: https://europepmc.org/article/med/8004830.
A. M. Cote and N. Sauve, �The management challenges of non-preeclampsiarelated nephrotic syndrome in pregnancy,� Obstetric Medicine, vol. 4, no. 4, pp. 133� 139, Dec. 2011, DOI: 10.1258/om.2011.110001.
K. Matsuo, E. L. Tudor, and A. A. Baschat, �Alport syndrome and pregnancy,� Obstetrics and Gynecology, vol. 109, no. 2 PART 2 SUPPL., pp. 531�532, Feb. 2007, DOI: 10.1097/01.AOG.0000240141.26395.82.
E. Yefet, D. Tovbin, and Z. Nachum, �Pregnancy outcomes in patients with Alport syndrome,� Archives of Gynecology and Obstetrics, vol. 293, no. 4, pp. 739�747, Apr. 2016, DOI: 10.1007/s00404-015-3893-9.
D. B. Nelson, �Minimal change glomerulopathy in pregnancy.,� Nephrology nursing journal�: journal of the American Nephrology Nurses� Association, vol. 30, no. 1, pp. 45�50, 55�6, 122, Feb. 2003, Accessed: Apr. 04, 2021. [Online]. Available: http://www.ncbi.nlm.nih.gov/pubmed/12674949.
M. Wu, Wang D, Zand L, Harris PC, White WM, Garovic VD, Kermott CA, �Pregnancy outcomes in autosomal dominant polycystic kidney disease: A case-control study,� Journal of Maternal-Fetal and Neonatal Medicine, vol. 29, no. 5, pp. 807�812, Mar. 2016, DOI: 10.3109/14767058.2015.1019458.
N. Vora, R. Perrone, and D. W. Bianchi, �Reproductive Issues for Adults With Autosomal Dominant Polycystic Kidney Disease,� American Journal of Kidney Diseases, vol. 51, no. 2. Am J Kidney Dis, pp. 307�318, Feb. 2008, DOI: 10.1053/j.ajkd.2007.09.010.
F. Dunne, �Type 2 diabetes and pregnancy,� Seminars in Fetal and Neonatal Medicine, vol. 10, no. 4, pp. 333�339, 2005, DOI: 10.1016/j.siny.2005.04.007.
�Management of diabetes in pregnancy: Standards of medical care in diabetes- 2020,� Diabetes Care, vol. 43, no. Suppl 1, pp. S183�S192, Jan. 2020, DOI: 10.2337/dc20-S014.
K. Rossing, Jacobsen P, Hommel E, Mathiesen E, Svenningsen A, Rossing P, Parving HH., �Pregnancy and progression of diabetic nephropathy,� Diabetologia, vol. 45, no. 1, pp. 36�41, 2002, DOI: 10.1007/s125-002-8242-4.
E. Bartsch, Medcalf KE, Park AL, Ray JG., �Clinical risk factors for preeclampsia determined in early pregnancy: Systematic review and meta-analysis of large cohort studies,� The BMJ, vol. 353, Apr. 2016, DOI: 10.1136/bmj.i1753.
P. Ekbom, P. Damm, B. Feldt-Rasmussen, U. Feldt-Rasmussen, J. Molvig, and E. R. Mathiesen, �Pregnancy outcome in type 1 diabetic women with microalbuminuria,� Diabetes Care, vol. 24, no. 10, pp. 1739�1744, 2001, DOI: 10.2337/diacare.24.10.1739.
A. Golan, S. Wexler, A. Amit, D. Gordon, and M. P. David, �Asymptomatic bacteriuria in normal and high-risk pregnancy,� European Journal of Obstetrics and Gynecology and Reproductive Biology, vol. 33, no. 2, pp. 101�108, 1989, DOI: 10.1016/0028-2243(89)90202-5.
B. Foxman, �Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs,� American Journal of Medicine, vol. 113, no. 1 SUPPL. 1, pp. 5�13, Jul. 2002, DOI: 10.1016/S0002-9343(02)01054-9.
P. S. Parfrey and J. D. Harnett, �Cardiac disease in chronic uremia: Pathophysiology and clinical epidemiology,� ASAIO Journal, vol. 40, no. 2. Lippincott Williams and Wilkins, pp. 121�129, 1994, DOI: 10.1097/00002480-199404000-00003.
S. Meher, N. Gibbons, and R. DasGupta, �Renal stones in pregnancy,� Obstetric Medicine, vol. 7, no. 3. Royal Society of Medicine Press Ltd, pp. 103�110, Sep. 27, 2014, DOI: 10.1177/1753495X14538422.
J. M. Riley, A. G. Dudley, and M. J. Semins, �Nephrolithiasis and pregnancy: Has the incidence been rising?,� Journal of Endourology, vol. 28, no. 3, pp. 383�386, Mar. 2014, DOI: 10.1089/end.2013.0570.
P. Maikranz, J. L. Holley, J. H. Parks, M. D. Lindheimer, Y. Nakagawa, and F. L. Coe, �Gestational hypercalciuria causes pathological urine calcium oxalate supersaturations,� Kidney International, vol. 36, no. 1, pp. 108�113, 1989, DOI: 10.1038/ki.1989.168.
S. D. Chung, Y. H. Chen, J. J. Keller, C. C. Lin, and H. C. Lin, �Urinary calculi increase the risk for adverse pregnancy outcomes: A nationwide study,� Acta Obstetricia et Gynecologica Scandinavica, vol. 92, no. 1, pp. 69�74, Jan. 2013, DOI: 10.1111/aogs.12016.
S. F. Leavey and W. F. Weitzel, �Endocrine abnormalities in chronic renal failure,� Endocrinology and Metabolism Clinics of North America, vol. 31, no. 1. Endocrinol Metab Clin North Am, pp. 107�119, 2002, DOI: 10.1016/S0889- 8529(01)00006-8. 8529(01)00006-8
M. A. Hladunewich, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M, Tennankore K, Keunen J, Hui D, Chan CT.�Intensive hemodialysis associates with improved pregnancy outcomes: A Canadian and United States cohort comparison,� Journal of the American Society of Nephrology, vol. 25, no. 5, pp. 1103�1109, May 2014, DOI: 10.1681/ASN.2013080825.
E. Rosenberg, Sergienko R, Abu-Ghanem S, Wiznitzer A, Romanowsky I, Neulander EZ, Sheiner E,, �Nephrolithiasis during pregnancy: Characteristics, complications, and pregnancy outcome,� World Journal of Urology, vol. 29, no. 6, pp. 743�747, Dec. 2011, DOI: 10.1007/s00345-011-0719-7.
M. Barua, Hladunewich M, Keunen J, Pierratos A, McFarlane P., Sood M, Chan CT, �Successful pregnancies on nocturnal home hemodialysis,� Clinical Journal of the American Society of Nephrology, vol. 3, no. 2, pp. 392�396, Mar. 2008, DOI: 10.2215/CJN.04110907.
K. Wiles, Chappell L, Clark K, Elamn L, Hall M, Lighstone L, Mohamed G, Mukherjee D, Nelson-Piercy C, Webster P, Whybrow R, Bramham K., �Clinical practice guideline on pregnancy and renal disease,� BMC Nephrology, vol. 20, no. 1. BioMed Central Ltd., pp. 1�43, Oct. 31, 2019, DOI: 10.1186/s12882-019-1560-2.
C. Luders, M Carlos, SM Titan, RM Elias, H Abensur, JE Romao Jr �Obstetric Outcome in Pregnant Women on Long-term Dialysis: A Case Series,� American Journal of Kidney Diseases, vol. 56, no. 1, pp. 77�85, Jul. 2010, DOI: 10.1053/j.ajkd.2010.01.018.
View or Download full articleAccess options
SWS access login
Login as SWS Scientific CommitteeLogin as SWS Scientific PartnerLogin as SWS AuthorAuthors and approved SWS contributors will read and export their own linked papers after identity matching by SWS profile, email and SGEM GlobalID.
For librarian assistance: [email protected]
Purchase Instant Access
- Article can be downloaded after successful payment.
- Article may be used according to SWS library access terms.
- Article cannot be redistributed.
