Pregnancy outcomes in autosomal dominant polycystic kidney disease: a case-control study

Wu, Min; Wang, Diping; Zand, Ladan; Harris, Peter C.; White, Wendy; Garovic, Vesna D.; Kermott, Cindy A.

doi:10.3109/14767058.2015.1019458

Cited by 88 publications

(26 citation statements)

References 18 publications

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“…The reported incidence of UTI in pregnancy in women with renal transplants is variable with cohorts reporting incidences of between 14 and 42% [253, 254]. An increased incidence of UTI in pregnancy is also described in women with reflux nephropathy [255–257] and polycystic kidney disease [258]. There are no published data to guide the management and prophylaxis of urinary tract infection specifically in women with CKD in pregnancy.…”

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

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The aim of this guideline is to improve the standard of, and to reduce regional variation in, the care of women with CKD in the UK who are pregnant, planning a pregnancy or post-partum. Scope This guidance covers the care of women with CKD (including renal transplant recipients) who are planning a pregnancy, pregnant, or in the post-partum period. It also covers contraception and fertility for women with CKD. This guideline can be used in the following settings: General practice Community and hospital antenatal clinics Antenatal, labour and postnatal wards Renal outpatients Renal wards Dialysis units The target audience and intended users of this guideline are nephrologists, obstetricians, obstetric physicians, midwives, renal nurses, pharmacists, specialist trainees in both nephrology and obstetrics, and women with CKD who are pregnant or considering pregnancy. Qualitative data on the experience of pregnancy and renal disease is provided in Appendix 1. A summary of clinical responsibility for elements of the guideline is provided in Appendix 2. The clinical issues covered in this guideline are: Structure of care Medication Pre-pregnancy care 3.1.Contraception 3.2.Fertility 3.3.Pre-pregnancy counselling and optimisation for pregnancy Pregnancy care 4.1 Assessment of renal function in pregnancy 4.2 Antenatal care 4.3 Pre-eclampsia prophylaxis 4.4 Blood pressure management 4.5 Thromboembolism prophylaxis 4.6 Anaemia 4.7 Bone health 4.8 Renal biopsy 4.9 Peripartum care 4.10 Postnatal care Pregnancy Care Assessment of renal function in pregnancy Guideline 4.1.1 We recommend renal function in pregnancy is assessed using serum creatinine concentrations as estimated GFR (eGFR) is not valid for use in pregnancy (1C). Guideline 4.1.2 We recommend women with CKD have formal quantification of proteinuria in pregnancy (1D). Guideline 4.1.3 We recommend quantification of proteinuria is undertaken by protein:creatinine ratio (uPCR) or albumin:creatinine ratio (uACR). Twenty-four hour urine collection for quantification of protein is not required (1B). Antenatal care Guideline 4.2.1 We suggest pregnant women with CKD who have not had pre-pregnancy counselling by the MDT are referred to the MDT and receive the same counselling and optimisation as for women attending pre-pregnancy (2D). Guideline 4.2.2 We recommend pregnant women with CKD receive routine antenatal care, in addition to specialist input (1D). Guideline 4.2.3 We recommend pregnant women with CKD be referred for assessment by a consultant obstetrician (1D). Guideline 4.2.4 We recommend pregnant women with CKD have access to usual trisomy screening with specialist interpretation of high-risk results (1C). Guideline 4.2.5 We recommend women with CKD exposed to teratogenic drugs in the first trimester are referred to a specialist fetal medicine unit (1D). Guideline 4.1.6 We recommend pregnant women with CKD have scans to assess fetal growth and wellbeing in the third trimester (1C). Guideline 4.2.7 We recommend pregnant women taking prednisolone and/or calcineurin inhib...

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Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

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“…This is the case of pregnant women with systemic lupus erythematosus with renal involvement, i.e., lupus nephritis, in whom an increased disease severity represents the major risk factor for prematurity [17]. Other renal diseases potentially affecting pregnancy outcomes include diabetic kidney disease, which is related to a higher risk of fetal malformation and perinatal death rates [18], and adult polycystic kidney disease that show a high prevalence of urinary infections and preterm delivery [19]. Moreover, there is a lack of a shared assessment (also due to difficulty to evaluate renal function) and management of CKD in pregnancy, mainly because performing clinical trials on pregnant patients presents obvious ethical issues [20].…”

Section: Pregnancy In Ckd Non-dialysis Womenmentioning

confidence: 99%

Nutritional Challenges in Pregnant Women with Renal Diseases: Relevance to Fetal Outcomes

et al. 2020

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Pregnancy in women affected by chronic kidney disease (CKD) has become more common in recent years, probably as a consequence of increased CKD prevalence and improvements in the care provided to these patients. Management of this condition requires careful attention since many clinical aspects have to be taken into consideration, including the reciprocal influence of the renal disease and pregnancy, the need for adjustment of the medical treatments and the high risk of maternal and obstetric complications. Nutrition assessment and management is a crucial step in this process, since nutritional status may affect both maternal and fetal health, with potential effects also on the future development of adult diseases in the offspring. Nevertheless, few data are available on the nutritional management of pregnant women with CKD and the main clinical indications are based on small case series or are extrapolated from the general recommendations for non-pregnant CKD patients. In this review, we discuss the main issues regarding the nutritional management of pregnant women with renal diseases, including CKD patients on conservative treatment, patients on dialysis and kidney transplant patients, focusing on their relevance on fetal outcomes and considering the peculiarities of this population and the approaches that could be implemented into clinical practice.

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“…As it will be further discussed, our knowledge on the specific risks linked with the different kidney diseases is limited; overall, we know more about glomerular diseases, and the most common ones, such as IgA nephropathy, are extensively studied; conversely, the specific risks associated with interstitial nephropathies or polycystic kidney disease (ADPKD) are not fully appreciated [ 7 , 9 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Piccoli

Zakharova

Attini

et al. 2018

JCM

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Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

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Pregnancy outcomes in autosomal dominant polycystic kidney disease: a case-control study

Cited by 88 publications

References 18 publications

Clinical practice guideline on pregnancy and renal disease

Clinical practice guideline on pregnancy and renal disease

Nutritional Challenges in Pregnant Women with Renal Diseases: Relevance to Fetal Outcomes

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

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