Pregnancy in Renal Transplant Patients a Review

Rudolph, J; Schweizer, Robert T.; Bartus, Stanley A.

doi:10.1097/00007890-197901000-00007

Cited by 113 publications

(22 citation statements)

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“…PRED is a glucocorticoid agent that crosses the placenta in animals and humans [5,6,7]. The enzyme 11-beta-hydroxysteroid dehydrogenase metabolizes glucocorticoids into their inactive 11-keto metabolite.…”

Section: Prednisonementioning

confidence: 99%

“…In women with grafted kidneys, the adverse effects of pregnancy on renal function closely depend on the glomerular filtration rate (GFR) before conception, i.e., renal function remains stable when GFR was previously normal but the renal function declines in women with moderately to severely impaired GFR before conception (serum creatinine level ≥1.5 mg/dl) [5]. In this later condition, many other factors may contribute to reduce the renal function: acute graft rejection [6], pre-eclampsia, diabetes mellitus, poor compliance with IS drugs, and anticalcineurine drug administration. Overall, 10%-15% of women with kidney grafts had worsening renal function during pregnancy, and graft loss occurred in 10%-20%.…”

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

“…Bacterial infections, mainly of the urinary tract (17%) [28], viral infections (herpes simplex, cytomegalovirus, hepatitis B), and fungal infections (Aspergillus, Pneumocystis) are more common in pregnant women administered IS agents [6,29] and are potential hazards for both the mother and the fetus. PRED, tacrolimus, or CsA may favor maternal hyperglycemia and increase the risk of gestational diabetes [30], tacrolimus being more diabetogenic than CsA [27].…”

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

“…This incidence varied according to the class of IS agents. The risk for LBW infants also increased when the delay between transplantation and pregnancy was small: 46% of babies born in the 1st year after the transplantation were of normal birth weight compared with 73% of those born in the 2nd year and 82% after 2 years [6].…”

Section: Intrauterine Growth Retardationmentioning

confidence: 99%

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In utero exposure to immunosuppressive drugs: experimental and clinical studies

Tendron¹,

Jb²,

Decramer³

2002

Pediatric Nephrology

101

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Over the last few decades, the number of pregnant women under immunosuppressive (IS) therapy following transplantation or autoimmune diseases has increased. At first, IS drugs, including prednisone, azathioprine, and cyclosporine A were used, but now new molecules such as tacrolimus and mycophenolate mofetil have appeared. These IS drugs cross the placental barrier and enter into the fetal circulation, which poses a risk for fetal development. Experimental data have shown that IS drugs often have deleterious effects on fetuses, while human data have reported an increased rate of abortion, prematurity, intrauterine growth retardation (IUGR), and low birth weight, without significant increases in malformation rates. However, only limited information is available about the newly used molecules. Although fetal and neonatal data are reassuring, long-term effects of IS drugs on fertility, immune response and renal function, as well as the consequences of prematurity and IUGR, should be monitored.

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Section: Prednisonementioning

confidence: 99%

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

Section: Complications In Pregnant Women Administered Immunosuppressimentioning

confidence: 99%

Section: Intrauterine Growth Retardationmentioning

confidence: 99%

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In utero exposure to immunosuppressive drugs: experimental and clinical studies

Tendron¹,

Jb²,

Decramer³

2002

Pediatric Nephrology

101

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“…Allograft rejection: It has been reported that serious rejection occurs in 9/;" of women with pregnancies lasting into the third trimester (Rudolph et al 1979). While this incidence of rejection is no greater than expected for non-pregnant transplant patients, it could be considered unusual because it has always been assumed that the privileged immunological state of pregnancy would benefit the transplant.…”

Section: Management Of Pregnancymentioning

confidence: 99%

The Kidney in Pregnancy: A Review

Davison

1983

J R Soc Med

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Nephrological reviews are usually accolades to progress in the field. Advances pertaining to renal structure and function, techniques to study them, and understanding renal disease and its treatment by dialysis and transplantation are examples. Unfortunately, the area of nephrology which relates to pregnancy has not advanced similarly and when clinicians are asked to advise whether or not women with kidney disease, a renal transplant or a history of previous pregnancies marred by severe hypertension, should conceive or if pregnant continue the gestation, it becomes obvious that data are scarce and opinions vary. This neglect is unfortunate as renal and hypertensive complications of pregnancy remain an important cause of morbidity and mortality in mother and fetus. This review focuses on (a) the renal changes which occur during normal pregnancy, stressing the relevance to clinical practice; (b) controversies surrounding some of the urinary tract problems encountered in pregnancy; (c) detection and management of chronic renal disease and the effect of pregnancy 'on remote prognosis; (d) the kidney in pre-eclampsia; (e) pregnancy in renal transplant and haemodialysis patients; and (f) acute renal failure in obstetric practice.

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The Effects of Immunosuppressive and Anti-inflammatory Medications on Fertility, Pregnancy, and Lactation

Janssen¹

2000

Archives of Internal Medicine

244

136

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Many rheumatic diseases affect women of childbearing age, and the medications used to treat these diseases may affect conception, pregnancy, fetal development, and lactation. Physicians who care for these women need to be aware of the potential adverse effects of these medications, and which medications can be used safely prior to conception and during pregnancy and lactation. Although reviews of individual classes of medications are available, there is no practical and comprehensive review that summarizes all of this information, and includes anticoagulant drugs and 2 recently approved drugs for rheumatoid arthritis. Women who take cytotoxic drugs should be informed of the risks of impaired fertility and congenital malformations, and must use effective methods of contraception. During pregnancy, nonsteroidal anti-inflammatory agents may be used until the last 6 weeks, and low to moderate doses of corticosteroids are safe throughout pregnancy. Among the disease-modifying agents, sulfasalazine and hydroxychloroquine treatment may be maintained. Cytotoxic drugs may be used after the first trimester to treat life-threatening disease. During lactation, prednisone, sulfasalazine, and hydroxychloroquine may be used cautiously. Women using heparin for treatment of antiphospholipid antibody syndrome should take measures to prevent bone loss. Men taking methotrexate, sulfasalazine, cyclosporine, azathioprine, or leflunomide should be apprised of the possibilities of infertility and teratogenicity.

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Pregnancy in Renal Transplant Patients a Review

Cited by 113 publications

References 0 publications

In utero exposure to immunosuppressive drugs: experimental and clinical studies

In utero exposure to immunosuppressive drugs: experimental and clinical studies

The Kidney in Pregnancy: A Review

The Effects of Immunosuppressive and Anti-inflammatory Medications on Fertility, Pregnancy, and Lactation

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