A best practice position statement on the role of the nephrologist in the prevention and follow-up of preeclampsia: the Italian study group on kidney and pregnancy

Abstract

Preeclampsia (PE) is a protean syndrome causing a transitory kidney disease, characterised by hypertension and proteinuria, ultimately reversible after delivery. Its prevalence is variously estimated, from 3 to 5% to 10% if all the related disorders, including also pregnancy-induced hypertension (PIH) and HELLP syndrome (haemolysis, increase in liver enzyme, low platelets) are included. Both nephrologists and obstetricians are involved in the management of the disease, according to different protocols, and the clinical management, as well as the role for each specialty, differs worldwide. The increased awareness of the role of chronic kidney disease in pregnancy, complicating up to 3% of pregnancies, and the knowledge that PE is associated with an increased risk for development of CKD later in life have recently increased the interest and redesigned the role of the nephrologists in this context. However, while the heterogeneous definitions of PE, its recent reclassification, an emerging role for biochemical biomarkers, the growing body of epidemiological data and the new potential therapeutic interventions lead to counsel long-term follow-up, the lack of resources for chronic patients and the increasing costs of care limit the potential for preventive actions, and suggest tailoring specific interventional strategies. The aim of the present position statement of the Kidney and Pregnancy Study Group of the Italian Society of Nephrology is to review the literature and to try to identify theoretical and pragmatic bases for an agreed management of PE in the nephrological setting, with particular attention to the prevention of the syndrome (recurrent PE, presence of baseline CKD) and to the organization of the postpartum follow-up.

What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

“…The risks increase with CKD progression, thus posing potentially challenging ethical issues around conception and maintaining of pregnancies [6-8]. We do know that PE increases the probability of hypertension and CKD in later years, but we have not evaluated a surveillance or renoprotective strategy to determine if progressive loss of kidney function can be attenuated [9-12]. …”

What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women’s Day

“…The risks increase with CKD progression, thus posing potentially challenging ethical issues around conception and maintaining of pregnancies [6][7][8]. We do know that PE increases the probability of hypertension and CKD in later years, but we have not evaluated a surveillance or renoprotective strategy to determine if progressive loss of kidney function can be attenuated [9][10][11][12].…”

What we do and do not know about women and kidney diseases – questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…The risks increase with CKD progression thus posing potentially challenging ethical issues around conception and maintaining of pregnancies . We do know that PE increases the probability of hypertension and CKD in later years, but we have not evaluated a surveillance or reno‐protective strategy to determine if progressive loss of kidney function can be attenuated …”