Maternal and Fetal Outcomes of Pregnancy in Nephrotic Syndrome Due to Primary Glomerulonephritis

Abstract

Chronic kidney disease (CKD) affects 3% of pregnancies, impacting on maternal and fetal outcomes, and at the same time, a recurrent question in nephrology regards gestation impact on kidney function. Observational studies stated that CKD stage, pre-existent hypertension, and proteinuria are the main predictors of possible complications, such as maternal CKD progression, maternal or fetal death, prematurity, small for gestational age (SGA) newborn, or admission to the neonatal intensive care unit. In this regard, given the prominence of proteinuria among other risk factors, we focused on primary nephrotic syndrome in pregnancy, which accounts for 0.028% of cases, and its impact on materno-fetal outcomes and kidney survival. Data extracted from literature are scattered because of the small cohorts investigated in each trial. However, they showed different outcomes for each glomerular disease, with membranous nephropathy (MN) having a better maternal and fetal prognosis than focal and segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), or minimal change disease (MCD). Nephrotic syndrome does not have to discourage women to undertake a pregnancy, but the correct management may include a specific evaluation of risk factors and follow-up for adverse materno-fetal events and/or maternal kidney disease progression.

Roles of interleukins (interleukin-18 and interleukin-17a) and transforming growth factor-beta markers in the pathogenesis of diabetic kidney diseases

“…[ 14 ] Studies conducted in Turkey suggest that DKD exhibits a higher prevalence in women compared to men, which was consistent with the results of the current study (Siligato et al ., 2020). [ 15 ] However, the previous research has shown mixed results, with 38 studies reporting a higher incidence of CKD in women and 13 studies reporting a higher prevalence in men (Hill et al ., 2016). [ 16 ] Furthermore, in contrast to these findings, males appear to have a greater risk of progressing to CKD (Ricardo et al ., 2019)[ 17 ] (Pugliese et al ., 2014).…”

Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors

“…Gender-related differences have been reported in non-diabetic chronic kidney disease (CKD) [ 8 ]. Overall, CKD seems to have a higher prevalence in women than in men [ 9 , 10 , 11 ]. However, a review including a large number of studies found 38 studies reporting a higher CKD prevalence in women and 13 among men [ 12 ].…”

Pregnancy and delivery in women receiving maintenance hemodialysis in Japan: analysis of potential risk factors for neonatal and maternal complications

“…Age at conception ≥ 38 years tended to have an increased association with maternal complications compared to ≤ 37 years, but neonatal complications developed in mothers whose ages were 32, 33 and 39 years. Furthermore, malnutrition suggested by sAlb ≤ 3.2 mg/dL in the first trimester appears to be a common risk for both maternal and neonatal complications [ 16 , 17 ]. These complex findings are in line with a previous report by Villar et al which proposed that preeclampsia (as a maternal complication) and FGR (as a neonatal complication) may have distinct etiologies among obstetric disorders [ 18 ].…”