Pregnancy in chronic kidney disease and kidney transplantation

Abstract

Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks. These pregnancies should be deemed high risk and they require close antenatal monitoring from an expert multidisciplinary team. We discuss the effect of pregnancy on CKD, and also current guidelines and literature with specific reference to transplantation, autoimmune disease, and medication use in pregnancy. We also discuss the benefits of prepregnancy counseling and give practical recommendations to advise pregnant women with renal disease

Kidneys and women's health: key challenges and considerations

“…In the UK renal function is not part of antenatal screening so baseline kidney function is not known in pregnancy. Physicians often do not realize that a seemingly normal creatinine level in pregnancy may reflect substantial renal impairment; creatinine levels should fall substantially in early pregnancy and not return to pre-pregnancy levels until late in the third trimester 39 . However, the key challenge is failing to follow up on abnormalities that are detected.…”

“…Ideally, pre-pregnancy planning should be the norm for all women with kidney disease; however, the advice might differ considerably depending on the available resources 39 . A woman with fairly advanced CKD might consider going ahead with a high-risk pregnancy that could require neonatal intensive care for her baby and lead to faster progression to chronic dialysis for her if these facilities are available.…”

Women and kidney disease: reflections on World Kidney Day 2018

“…Indications on when to start dialysis in pregnancy are not well established, nor is there a specificity of frequency and duration. In those with kidney transplants, given the changing expanded donor policies, higher age at transplantation and reduced fertility in older women, there may be changes in attitudes toward pregnancy with less than optimal kidney function [15]. How this will impact short-and long-term outcomes of mothers and their babies is not clear.…”

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

“…Репродуктивная способность отчасти восста-навливается после трансплантации почки [56][57][58][59][60]. Однако даже в идеальной ситуации (нормальная функция трансплантата, отсутствие гипертен-зии и протеинурии и как минимум 2 года после Позднее созревание нефронов ведет к уменьшению их количества у недоношенных детей; риск, вероятно, выше для МГВП и детей с ВУЗР, по сравнению с недоношенными детьми нормального для гестационного возраста веса Другие отдаленные последствия Нарушения развития В основном развиваются вследствие преждевременных родов -внутримозговые кровоизлияния и неонатальный сепсис не являются специфичными для ХБП, но угрожают всем преждевременно рожденным детям СКВ -системная красная волчанка, ОПП -острое почечное повреждение, СКФ -скорость клубочковой фильтрации, сКр -сывороточный креатинин, ХБП -хроническая болезнь почек, ВПАК -волчаночноподобный антикоагулянт, ПЭ-ОПП -преэклампсия -острое почечное повреждение, МГВП -маленький для гестационного возраста плод, ВУЗР -внутриутробная задержка развития, ММФ -микофенолата мофетил, mTor -механистическая мишень рапамицина, иАПФ -ингибитор ангиотензинпревращающего фер-мента, БРА -блокатор рецептора ангиотензина II, ПКБП -поликистозная болезнь почек, ВАПМП -врожденные аномалии почек и мочевых путей, IgA -иммуноглобулин A трансплантации без эпизодов отторжения) риск осложнений у женщин с трансплантированной почкой выше, чем в общей популяции.…”