Chronic Kidney Disease in Pregnancy

Koratala, Abhilash; Bhattacharya, Deepti; Kazory, Amir

doi:10.14423/smj.0000000000000693

Cited by 8 publications

(6 citation statements)

References 40 publications

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“…Koratala et al 13 found that kidney damage occurring during pregnancy was linked to adverse pregnancy outcomes. This study found that, in the pregnancy-related renal damage group, the foetal survival rate was 77.1%, which was comparable to previous reports.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and prognosis of pregnancy-related renal damage and pregnancy after chronic kidney disease

Shen

zhang

et al. 2023

Preprint

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Objective: Explore the different clinical features of pregnancy-related renal damage and pregnancy after chronic kidney disease(CKD), so as to provides the clinical basis for the relationship between renal damage and pregnancy. Methods:Retrospective analysis the patients with pregnancy and kidney damage admitted to our hospital between March 2013 and February 2021. Collect the pathology results of renal biopsy, 24-hour urinary protein quantity, albumin(Alb), serum creatinine（Scr）, blood lipids, coagulation function, blood routine and other indicators during pregnancy and postpartum period. Results: A total of 82 cases were included in this study, including 48 cases in pregnancy-related renal damage group, of which 11 cases (22.92%) were terminated pregnancy. 34 cases in the post-CKD pregnancy group, of which 1 case (2.94%) were terminated pregnancy. There were 30 cases (88.24%) of CKD stage 1-2, the pregnancy outcome and fetal outcome were better in the post-CKD pregnancy group than in the pregnancy-related renal damage group (Ρ was 0.029, 0.036 respectively), there was no statistical significance in the comparison of fetal weight between the two groups (Ρ>0.05). In renal biopsy pathology, 16 cases (33.33%) were mainly focal segmental glomerulosclerosis (FSGS) in the pregnancy-related renal damage group, the post-CKD pregnancy group was dominated by 14 cases (43.75%) of IgA nephropathy. Comparison of the first indicators of pregnancy between the two groups showed that estimated glomerular filtration（eGFR）and Alb in the pregnancy-related renal damage group were lower than those in the post-CKD pregnancy group (Ρ was 0.003, 0.000 respectively). Meanwhile, 24-hour urinary protein quantity, total cholesterol（Tch）, triglyceride(TG), and platelet (PLT) counts were higher than the post-CKD pregnancy group (Ρ was 0.005, 0.001, 0.008, 0.031 respectively). The abnormal rate of Scr during pregnancy was 41.67% (20/48) in the pregnancy-related renal damage group, 17.39% (4/23) in the post-CKD pregnancy group, and the abnormal rate of Scr during pregnancy in the two groups was statistically significant (Ρ was 0.043 respectively). Conclusion: The pathological type of the pregnancy-related renal damage group is mainly FSGS, and the post-CKD pregnancy group is dominated by IgA nephropathy. Patients with stage CKD1-2 can have an active pregnancy after the well control of eGFR, albumin, 24-hour urinary protein quantity and other indicators, there are better pregnancy and fetal outcomes. Abnormal Scr during pregnancy of pregnancy-related renal damage can be improved after 3 months postpartum.

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Section: Discussionmentioning

confidence: 99%

Clinical features and prognosis of pregnancy-related renal damage and pregnancy after chronic kidney disease

Shen

zhang

et al. 2023

Preprint

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“…Hence, they should be pre-conceptionally counseled for the same. 2 Whereas, with CKD, maternal hypertension and proteinuria not only deteriorate the CKD stage but also act as independent risk factors for poor outcome of pregnancy. Patients with immunologic diseases and glomerulonephritis are at a higher risk of developing a pre-eclampsia like picture with hypertension and proteinuria; often difficult to differentiate.…”

Section: Discussionmentioning

confidence: 99%

Impact of chronic kidney disease on fetomaternal outcome: a case report

Khairnar

Bora

Bava

2021

Int J Reprod Contracept Obstet Gynecol

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Chronic kidney disease is a heterogenous group of disorders resulting from anatomical and physiological alterations in the kidney. Pregnancy might accelerate the renal disease-causing progression of renal failure, development of preeclampsia, anemia. This increases the risk of adverse fetomaternal outcomes including prematurity, fetal growth restriction, fetal deaths and development of hypertension, nephrotic syndrome, renal failure in the mother. Chronic kidney disease affects approximately 3% of pregnant women. This study was carried out to assess the course of chronic kidney disease in pregnancy and the effect it has on the fetal outcome. A case of chronic kidney disease presenting to the OBGY emergency unit was studied. a detail history was taken and examination was done. Baseline antenatal investigations were carried out. Special tests including renal Doppler, ophthalmoscopic examination, ECG, were done to assess the renal function. Treatment was started for control of hypertension and further progression of the disease. Pregnancy has adverse outcome when associated with acute kidney injury. Maternal hypertension and proteinuria are the major predisposing factors. Prematurity is one of the commonest fetal complications apart from growth restriction. Chronic kidney disease in pregnancy requires a multidisciplinary approach involving experienced obstetricians, nephrologists, radiologists, intensivists and neonatologists. The etiology, degree of renal dysfunction, development of additional obstetric complications determines the prognosis. Supportive therapy in the early course of the disease and timely definitive management as per the etiology is found to improve the feto-maternal outcome.

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“…Some recent reviews on pregnancy in CKD showed that patients usually had different renal and pregnancy outcomes due to different types of primary renal diseases, CKD stages, the presence of HTN and proteinuria [27][28][29][30][31][32]. Patients with various diseases such as lupus nephropathy or diabetic nephropathy might have a higher incidence of renal and pregnancy complications [33][34][35][36][37][38][39], while those with other glomerular diseases, such as IgAN and minimal change disease, had limited disease-specific data to guide pregnancy counseling.…”

Section: Discussionmentioning

confidence: 99%

Renal Outcomes of Pregnant Patients with Immunoglobulin A Nephropathy: A Systematic Review and Meta-Analysis

Wang

Zhu

et al. 2019

Am J Nephrol

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Background: Is the prognosis of immunoglobulin A nephropathy (IgAN) influenced by pregnancy and delivery? The answer to this question still remains to be a controversial topic. Here, we undertook a systematic review and meta-analysis to obtain the overall estimate of potential effect of IgAN and pregnancy on each other. Methods: We systematically searched MEDLINE, EMBASE, Chinese Biological Medicine and Cochrane for cohort and case-control studies; a total of 1,378 articles were reviewed and 9 studies were included in the end. OR and mean difference (MD) were calculated with a random-effects model, kidney events and pregnancy outcomes were analyzed respectively. Results: The key finding of the meta-analysis of 145 renal events in 1,198 participants was that there was no difference in renal outcomes (defined as doubling of serum creatinine (SCr), 50% decline in glomerular filtration rate [GFR] and end-stage kidney disease) of pregnant women compared with non-pregnant women who had IgAN (OR 0.90; 95% CI 0.59–1.37; p = 0.63). Subgroup analysis indicated that there was no significant difference between the 2 groups according to sample size, follow-up year, age, level of SCr and proteinuria at baseline. There was no difference in the change of the eGFR/creatinine clearance rate (mL/min/1.73 m² per year) in IgAN patients with pregnancy compared with non-pregnancy (MD –0.11 mL/min; 95% CI –0.50–0.27; p = 0.57) as well. Women with IgAN had a higher likelihood of pregnancy outcomes compared with the Chinese general population, while they had a lower risk of preterm delivery, preeclampsia and low birth weight compared with those who had lupus nephritis or diabetic nephropathy. Conclusions: Pregnancy did not accelerate kidney disease deterioration in women with IgAN in stages of chronic kidney disease 1–3. Moreover, patients with IgAN had a relatively low risk of adverse pregnancy events compared with those with lupus nephritis or diabetic nephropathy.

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Chronic Kidney Disease in Pregnancy

Cited by 8 publications

References 40 publications

Clinical features and prognosis of pregnancy-related renal damage and pregnancy after chronic kidney disease

Clinical features and prognosis of pregnancy-related renal damage and pregnancy after chronic kidney disease

Impact of chronic kidney disease on fetomaternal outcome: a case report

Renal Outcomes of Pregnant Patients with Immunoglobulin A Nephropathy: A Systematic Review and Meta-Analysis

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