Women’s Reproductive Health for the Nephrologist

Burgner, Anna; Hladunewich, Michelle A.

doi:10.1053/j.ajkd.2019.04.017

Cited by 20 publications

(16 citation statements)

References 67 publications

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“…Women with kidney failure and earlier stages of CKD, including kidney transplant recipients, have a noteworthy higher risk for developing PE during pregnancy. 20,60 HELLP syndrome is considered a severe form of PE, although some authors still defend it to be a separate disorder. 61 The predominant features of this syndrome include hemolysis, elevated liver enzymes, and thrombocytopenia, rather than hypertension or central nervous system or renal dysfunction, although the latter also occurs.…”

Section: Specific Renal Diseases Primary Glomerulonephritismentioning

confidence: 99%

“…19 The decrease in glomerular filtration rate can influence sexual hormones, specifically the estrogen--mediated positive feedback, and the inhibition of the estradiol-stimulated LH surge seems to be the main factor responsible for anovulatory cycles and amenorrhea in women with CKD. 19,20 Sexual dysfunction etiology is complex, with both psychological and biological factors taking part. Some of the symptoms consist of decreased sexual activity and interest (frequently due to negative body image, even before dialysis), impairment of orgasm, insufficient vaginal lubrication, dyspareunia, and vaginismus.…”

Section: Introductionmentioning

confidence: 99%

“…Pathologies such as PE and FGR are accountable for most cases of fetal demise, PT birth, and neonatal death in women with CKD. 20,25,26 The probability for these complications increases with the progression of renal dysfunction and with the appearance of proteinuria and/or hypertension. 14,27,28 Some of the drugs used in CKD women to slow the progression of renal disease, treat hypertension, or flares of specific underlying diseases (for example, lupus nephritis) can also be harmful for the fetus and some couse a demonstrated pattern of malformations.…”

Section: Introductionmentioning

confidence: 99%

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Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

et al. 2021

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Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

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Section: Specific Renal Diseases Primary Glomerulonephritismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

et al. 2021

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“…Pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity/mortality and progression to kidney failure. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies and to choose treatments that preserve fertility [61].…”

Section: Endocrine and Fertility Issuesmentioning

confidence: 99%

An Interdisciplinary Approach to Optimize the Care of Transitioning Adolescents and Young Adults with CKD

Ferris

Martínez

Velázquez³

et al. 2021

Blood Purif

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Adolescents and young adults (AYAs) with CKD or end-stage kidney disease (ESKD) have unique medical, dental, psychosocial, neurocognitive, and academic needs and require close interdisciplinary collaboration to optimize their care. The etiology of CKD in AYAs is diverse compared to older adults. With their continuously improved survival, AYAs must start preparation for health-care transition (HCT) from pediatric- to adult-focused health care in the pediatric setting and it must continue at the adult-focused setting, given that their brain maturation and self-management skill acquisition occur until their mid-20s. While the growth and physical maturation of most visible body parts occur before 18 years of age, the prefrontal cortex of the brain, where reasoning, impulse control, and other higher executive functions reside, matures around 25 years of age. The HCT process must be monitored using patient- and caregiver-measuring tools to guide interventions. The HCT process becomes more complex when patients and/or caregivers have a language barrier, different cultural beliefs, or lower literacy levels. In this article, we discuss the unique comorbidities of pediatric-onset CKD/ESKD, provide information for a planned HCT preparation, and suggest interdisciplinary coordination as well as cultural and literacy-appropriate activities to achieve optimal patient outcomes.

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“…Some recent reviews have addressed the issue of contraception in CKD; they all acknowledge the lack of detailed, specific evidence deriving from primary studies on CKD women [17][18][19][20][21]. The high heterogeneity of CKD stages, type of disease and treatment is one of the reasons for this lack of evidence or of the use of low-quality evidence, even in the fields most often studied (kidney transplantation, lupus nephropathy and diabetic nephropathy) [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

et al. 2020

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Even though fertility is reduced, conception and delivery are possible in all stages of CKD. While successful planned pregnancies are increasing, an unwanted pregnancy may have long-lasting deleterious effects, hence the importance of birth control, an issue often disregarded in clinical practice. The evidence summarized in this position statement is mainly derived from the overall population, or other patient categories, in the lack of guidelines specifically addressed to CKD. Oestroprogestagents can be used in early, non-proteinuric CKD, excluding SLE and immunologic disorders, at high risk of thromboembolism and hypertension. Conversely, progestin only is generally safe and its main side effect is intramestrual spotting. Non-medicated intrauterine devices are a good alternative; their use needs to be carefully evaluated in patients at a high risk of pelvic infection, even though the degree of risk remains controversial. Barrier methods, relatively efficacious when correctly used, have few risks, and condoms are the only contraceptives that protect against sexually transmitted diseases. Surgical sterilization is rarely used also because of the risks surgery involves; it is not definitely contraindicated, and may be considered in selected cases. Emergency contraception with high-dose progestins or intrauterine devices is not contraindicated but should be avoided whenever possible, even if far preferable to abortion. Surgical abortion is invasive, but experience with medical abortion in CKD is still limited, especially in the late stages of the disease. In summary, personalized contraception is feasible, safe and should be offered to all CKD women of childbearing age who do not want to get pregnant.

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Women’s Reproductive Health for the Nephrologist

Cited by 20 publications

References 67 publications

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

An Interdisciplinary Approach to Optimize the Care of Transitioning Adolescents and Young Adults with CKD

Contraception in chronic kidney disease: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology

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