Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

Abstract

Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

“…18 This is in contrast to patients experiencing hypertension during pregnancy who have a poor prognosis and outcome. 19 So, accurate diagnosis of renal function, during pregnancy, depends on the ability of sonographers or sonologists to detect changes in renal volume, during a normal pregnancy and also as a side effect of PIH, which can cause an adverse pregnancy outcome. Achieving this goal would depend on having a range of renal volumes, throughout a normal pregnancy, so that any change in these dimensions could be attributed to a suspected pathologic change.…”

Doença Hipertensiva Específica da Gestação: evolução científica na relação da pré-eclâmpsia com a morbimortalidade materna / Pregnancy-Specific Hypertensive Disease: scientific evolution in the relationship between pre-eclampsia and maternal morbidity and mortality

“…Por sua vez, esta equipe deve ser mantida informada a respeito da evolução da gravidez e tratamentos administrados à gestante, por meio de contra referência e de busca ativa das gestantes em seu território de atuação, bem como da visita domiciliar. (BRASIL, 2010;CANDIDO AC, 2020;GONZALES-WONG C, 2021;GOUVEIA IF, 2021).…”

The Impact of Nutrient Intake and Metabolic Wastes during Pregnancy on Offspring Hypertension: Challenges and Future Opportunities

“…Moreover, fetal metabolic wastes are transferred into the maternal circulation via the placenta and eliminated by maternal urination. Accordingly, neonates born to mothers with chronic kidney disease (CKD) are at risk for preterm birth, low birth weight, small size for gestational age, stillbirth and neonatal mortality [ 16 ].…”