Pregnancy and Chronic Kidney Disease

Piccoli, Giorgina Barbara; Attini, Rossella; Vasario, Elena; Conijn, A.P.; Biolcati, Marilisa; D’Amico, Federica; Consiglio, Valentina; Bontempo, Salvatore; Todros, Tullia

doi:10.2215/cjn.07911109

Cited by 184 publications

(186 citation statements)

References 42 publications

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“…As for maternal renal outcomes, across the functional stages there is a trend toward a higher risk of onset of hypertension (considering only the normotensive cases at baseline: 7.9% in stage 1 to 50% in stages 4-5), development or doubling of proteinuria (20.5% in stage 1 to 86.5% in stage 3 and 70% in stages [4][5] and shift of at least one functional stage or start of dialysis. One patient alone (in Cagliari), already in stage 5 at referral, started dialysis in pregnancy, whereas three patients shifted by two stages (two in Torino and one in Cagliari, all in stage 2 at the start of pregnancy).…”

Section: Pregnancy-related Outcomes: Ckd Stagementioning

confidence: 99%

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

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CKD is increasingly prevalent in pregnancy. In the Torino-Cagliari Observational Study (TOCOS), we assessed whether the risk for adverse pregnancy outcomes is associated with CKD by comparing pregnancy outcomes of 504 pregnancies in women with CKD to outcomes of 836 low-risk pregnancies in women without CKD. The presence of hypertension, proteinuria (.1 g/d), systemic disease, and CKD stage (at referral) were assessed at baseline. The following outcomes were studied: cesarean section, preterm delivery, and early preterm delivery; small for gestational age (SGA); need for neonatal intensive care unit (NICU); new onset of hypertension; new onset/doubling of proteinuria; CKD stage shift; "general" combined outcome (preterm delivery, NICU, SGA); and "severe" combined outcome (early preterm delivery, NICU, SGA). The risk for adverse outcomes increased across stages (for stage 1 versus stages 4-5: "general" combined outcome, 34.1% versus 90.0%; "severe" combined outcome, 21.4% versus 80.0%; P,0.001). In women with stage 1 CKD, preterm delivery was associated with baseline hypertension (odds ratio [OR], 3.42; 95% confidence interval [95% CI], 1.87 to 6.21), systemic disease (OR, 3.13; 95% CI, 1.51 to 6.50), and proteinuria (OR, 3.69; 95% CI, 1.63 to 8.36). However, stage 1 CKD remained associated with adverse pregnancy outcomes (general combined outcome) in women without baseline hypertension, proteinuria, or systemic disease (OR, 1.88; 95% CI, 1.27 to 2.79). The risk of intrauterine death did not differ between patients and controls. Findings from this prospective study suggest a "baseline risk" for adverse pregnancy-related outcomes linked to CKD.

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Section: Pregnancy-related Outcomes: Ckd Stagementioning

confidence: 99%

Risk of Adverse Pregnancy Outcomes in Women with CKD

Piccoli¹,

Cabiddu²,

Attini³

et al. 2015

Journal of the American Society of Nephrology

Self Cite

294

335

View full text Add to dashboard Cite

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“…Preterm delivery and early preterm delivery were defined as deliveries occurring before 37 and 34 completed weeks of gestational age, respectively. Apgar scores were recorded at 1 and 5 minutes by neonatologists (18,34).…”

Section: Definitionsmentioning

confidence: 99%

“…Children born to mothers with CKD are at higher risk of being small and/or premature, and premature children may display increased risk of CKD later in life (14)(15)(16)(17)(18). Despite heterogeneous medical literature, the overall risk of delivering small children parallels CKD progression (16)(17)(18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

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Association of Low-Protein Supplemented Diets with Fetal Growth in Pregnant Women with CKD

Piccoli¹,

Leone²,

Attini

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Women affected by CKD increasingly choose to get pregnant. Experience with lowprotein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets.Design, setting, participants, & measurements This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (.1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies-21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 proteinunrestricted meals allowed per week.Results Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P,0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups.Conclusion Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

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“…Este fenómeno se acentúa a medida que disminuye la función renal y en pacientes con ERC en etapas 4 y 5, 75% de los RN son pequeños para la edad gestacional y 100% de los partos son prematuros, con un promedio de edad gestacional de 32 semanas, lo cual es bastante similar a nuestros resultados. En la serie de Piccoli, la proteinuria mayor a 1 g/día se correlacionó con el requerimiento de cuidados neonatológicos intensivos y la hipertensión arterial con el parto prematuro 10,11 .…”

Section: Discussionunclassified