Association of Unilateral Renal Agenesis With Adverse Outcomes in Pregnancy: A Matched Cohort Study

Abstract

Background Data regarding the effect of a solitary kidney during pregnancy have come from studies of living kidney donors. We evaluated the risk of adverse pregnancy outcomes in women with a single kidney from renal agenesis. Study Design Matched cohort study. Setting and Participants Using data from 7,079 childbirths from an integrated health care delivery system from 1996 through 2015, we identified births from women with renal agenesis. Only first pregnancies and singleton births were included. After excluding those with diabetes and kidney disease, a total of 200 women with renal agenesis were matched 1:4 by age (within 2 years), race, and history of hypertension to women with two kidneys. Predictor Renal agenesis defined by ICD-9 codes prior to pregnancy. Outcomes The primary outcome was adverse maternal outcomes including preterm delivery, delivery via cesarean section, preeclampsia/eclampsia, and length of stay at hospital. Adverse neonatal endpoints were considered as a secondary outcome and included low birth weight (<2,500 g) and infant death/transfer to acute inpatient facility. Results The mean gestational age at delivery was 37.9 ± 2.1 weeks for women with renal agenesis compared to 38.6 ± 1.8 weeks for women with two kidneys. Compared to women with two kidneys, those with renal agenesis had an increased risk of preterm delivery (OR, 2.88; 95% CI, 1.86-4.45), delivery via cesarean section (OR, 2.11; 95% CI, 1.49-2.99), preeclampsia/eclampsia (OR, 2.41; 95% CI, 1.23-4.72), and length of stay >3 days (OR, 1.81; 95% CI, 1.18-2.78). Renal agenesis was not significantly associated with an increased risk of infant death/transfer to acute facility (OR, 2.60; 95% CI, 0.57-11.89) or with low birth weight after accounting for preterm delivery (OR, 2.11; 95% CI, 0.76-5.88). Limitations Renal agenesis was identified by ICD-9 code not by abdominal imaging. Conclusion Women with unilateral renal agenesis have a higher risk of adverse outcomes in pregnancy.

Herlyn-Werner-Wunderlich Syndrome in pregnancy

“…[1][2][3][4][5] Pregnancy with HWWS is a high risk pregnancy, because its correlated with Recurrent Pregnancy Lost (RPL), malpresentation, Intrauterine Growth Restriction (IUGR), preterm, PPROM, preeclampsia and placenta accreta. [9][10][11][12] Its difficult to diagnosis HWWS because of the rarity of this case, high suspectious is needed. In case 1, the diagnosis was by USG, because of uterus didelphys, we suspect there is others anomaly, patient underwent laparo-vaginoscopy and to confirm diagnosis of HWWS BNO-IVP was done which revealed renal agenesis.…”

“…In second case after pregnancy at 5/6 weeks AOG patient underwent the resection of the vaginal septum and drainage of pus, it maybe due to ascending infection from the vagina. [12][13][14][15] The complication of pregnancy with HWWS can be prevent by Preconception Counseling (PCC) before get pregnant. In both cases, the patient had severe preeclampsia, which can be prevent by given aspirin low dose as early 13 weeks AOG.…”

Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn

“…reported a significant correlation between renal agenesis and increased risk for pre‐eclampsia (odds ratio, OR, 2.41) . Hence, we considered that the number of cases in our study was too low to assess the risk of HDP in patients with renal agenesis, and further studies are required to assess the risk of HDP.…”

Emerging problems in uterus transplantation

“…Among pregnancy complications, pre‐eclampsia was found in several patients. The solitary kidney associated with atypical MRKH syndrome might be associated with a higher risk for adverse outcomes in pregnancy, including preterm delivery, delivery by caesarean section, and pre‐eclampsia/eclampsia . Adverse effects of immunosuppressants may also play a role in the development of pre‐eclampsia, and high‐risk pregnancy monitoring is necessary.…”

“…The solitary kidney associated with atypical MRKH syndrome might be associated with a higher risk for adverse outcomes in pregnancy, including preterm delivery, delivery by caesarean section, and preeclampsia/eclampsia. [9][10][11] Adverse effects of immunosuppressants may also play a role in the development of preeclampsia, and high-risk pregnancy monitoring is necessary. There has been a concern that immunosuppressants could induce deformity in children; however, the team in Sweden reported good development in newborns with no deformities.…”