Renal Disease in Women With Severe Preeclampsia or Gestational Proteinuria

Pregnancy Outcomes in Women with Chronic Kidney Disease

“…Most studies were done in North America (n ϭ 7), followed by Europe (n ϭ 3), Japan (n ϭ 2), and South America (n ϭ 1). Of the 13 studies, eight provided a definition for CKD (8,12,20,22,24 -27), two identified CKD through medical coding (2,19), and two defined their CKD population through kidney biopsy (21,23). One study did not report their definition of CKD (7).…”

“…Some women with CKD had a history of hypertension or proteinuria before pregnancy, which may have influenced the ascertainment of outcomes such as pre-eclampsia (2,7,19,21,26,27). Seven studies had a control group of normal healthy women (2,7,19,22,23,25,27) and the remaining six studies had a control group of women with other comorbidities but with normal kidney function (8,12,20,21,24,26). These comorbidities included diabetes mellitus, hypertension in patients with IgA nephropathy, and lupus nephritis (all with normal kidney function as defined by the primary authors).…”

“…The other large retrospective cohort study used an administrative database (2). Of the 13 studies, seven collected data prospectively (8,12,20,(23)(24)(25)(26) and six used pre-existing data from health records (2,7,19,21,22,27). Seven studies accounted for potential confounding factors such as maternal age, parity, race, socioeconomic status, diabetes status, trimester of first antenatal visit, smoking, year of delivery, marital status, place of childbirth, hospital, attending clinician, maternal education, alcohol use, medication used during the study period, and early antenatal referral (2,8,19,20,22,25,27).…”

“…Serum creatinine levels were reported in five studies and ranged from 0.8 to 4.61 mg/dl (70 to 407 mol/L) in women with CKD (8,20,22,24,27). All studies except four reported outcomes on singleton pregnancies (7,21,23,26). One study included a small percentage of women (5%) who had acute glomerulonephritis/acute renal failure (19).…”

Identifying atypical preeclampsia: A diagnostic challenge

“…Preeclampsia causing mild transient renal impairment (creatinine up to 1.4 mg/dL) is common, but with appropriate management, there should be complete recovery of renal function [2] . Conversely, 2% to 5% of women with preeclampsia are later found to have underlying renal disease, but if given diagnosis of preeclampsia with severe features, up to 20% of women will have chronic kidney disease (CKD) [3] . Women with preeclampsia with severe features and renal impairment (serum creatinine ≥ 1.36 mg/dL) should have their fluid balance guided by a central venous pressure catheter or, when available, a pulmonary artery flotation catheter on a high dependency unit familiar with this equipment [4] .…”