Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function

Abstract

The influence of pregnancy on the progression of diabetic nephropathy in diabetic women with pre-existing moderate renal insufficiency is a subject of considerable controversy in the literature. In four of five female patients with type I diabetes mellitus with pre-existing impaired renal function (creatinine clearance less than 80 ml/min), significant proteinuria (greater than 2 g/24 h urine) and hypertension we have found a further decline in renal function during pregnancy, with an increased deterioration rate of creatinine clearance in comparison to the time before and after pregnancy. The mean decline of the glomerular filtration rate was 1.8 ml/min per month during pregnancy and 1.4 ml/min per month postpartum until the start of dialysis treatment. The difference in the progression of diabetic nephropathy during and after pregnancy can be explained by increased hypertension during pregnancy, especially in the third trimester, despite an intensified antihypertensive therapy. The long-term effect of pregnancy on renal function in our patients was therefore an earlier requirement for renal replacement therapy than would have been expected without pregnancy.

Pregnancy and progression of diabetic nephropathy

“…Studies on patients with reduced kidney function (above upper limit of normal serum creatinine) in diabetic and non-diabetic nephropathy have, however, suggested a permanent deterioration in renal function [8] [2] with an increased risk of end stage renal disease and death within a few years after delivery.…”

Obstetric Nephrology

“…In women with normal serum creatinine, pregnancy was not associated with a greater decline in kidney function or impaired long-term maternal survival (20). However, other studies report that there is increased risk of deterioration of kidney function during pregnancy in women with a reduced creatinine clearance (5,21,22).…”

Type 1 Diabetes, Diabetic Nephropathy, and Pregnancy: A Systematic Review and Meta-Study

“…Abbreviations: Ctrls -controls, DN -diabetic nephropathy, IDDM -insulin-dependent diabetes mellitus, nnumber of pregnancies, NR -not reported, PE -pre-eclampsia, Pro -prospective, Pts -patients, Ret -retrospective. References [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63].…”

“…Abbreviations: BP -blood pressure, Compl -complications, Ctrl -control, ESRD -end-stage renal disease, IUGR -intrauterine growth restriction, LN -lupus nephritis, Macroalb -macroalbuminuria, MAP -mitogen-activated protein, Microalb -microalbuminuria, MPGN -membranoproliferative glomerulonephritis, Nephro -nephropathy, Normoalb -normoalbuminuria, NR -not reported, OR -odds ratio, Preg -pregnant, Prot -proteinuria, RR -relative risk, sCr -serum creatinine, SGA -small for gestational age, SLE -systemic lupus erythematosis, UAE -urinary albumin excretion. References [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63].…”