Pregnancy and Chronic Kidney Disease
Open Access
- 1 May 2010
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Journal of the American Society of Nephrology
- Vol. 5 (5), 844-855
- https://doi.org/10.2215/cjn.07911109
Abstract
Background and objectives: Chronic kidney disease (CKD) is a challenge for pregnancy. Its recent classification underlines the importance of its early phases. This study9s aim was to evaluate outcomes of pregnancy according to CKD stage versus low-risk pregnancies followed in the same center. Design, setting, participants, & measurements: The prospective analysis was conducted from January 2000 to May 2009 with the start of observation at referral and end of observation 1 month after delivery. Ninety-one singleton deliveries were studied; 267 “low-risk” singleton pregnancies served as controls. Because of the lack of hard end points (death, start of dialysis), surrogate end points were analyzed (cesarean section, prematurity, neonatal intensive care). Results: CKD outcome was worse than physiologic pregnancies: preterm delivery (44% versus 5%); cesarean section (44% versus 25%); and need for neonatal intensive care (26% versus 1%). The differences were highly significant in stage 1 CKD (61 cases) versus controls (CKD stage 1: cesarean sections = 57%, preterm delivery = 33%, intensive care = 18%). In CKD, proteinuria and hypertension were correlated with outcomes [proteinuria dichotomized at 1 g/24 h at referral: need for intensive care, relative risk (RR) = 4.16 (1.05 to 16.46); hypertension: preterm delivery, RR = 7.24 (2.30 to 22.79); cesarean section, RR = 5.70 (1.69 to 19.24)]. Statistical significance across stages was reached for preterm delivery [RR = 3.32 (1.09 to 10.13)]. Conclusions: CKD is a challenge for pregnancy from early stages. Strict follow-up is needed for CKD patients, even when there is normal renal function.Keywords
This publication has 45 references indexed in Scilit:
- Low saliva progesterone concentrations are associated with spontaneous early preterm labour (before 34 weeks of gestation) in women at increased risk of preterm deliveryBJOG: An International Journal of Obstetrics and Gynaecology, 2009
- CKD ClassificationJournal of the American Society of Nephrology, 2009
- Chronic kidney disease in pregnancyBMJ, 2008
- Assessment of glomerular filtration rate during pregnancy using the MDRD formulaBJOG: An International Journal of Obstetrics and Gynaecology, 2007
- Estimation of Glomerular Filtration Rate in Preeclamptic PatientsAmerican Journal of Perinatology, 2007
- Acute pyelonephritis in pregnancy: A retrospective studyAustralian and New Zealand Journal of Obstetrics and Gynaecology, 2007
- Maternal and fetal outcomes of 72 pregnancies in Argentine patients with systemic lupus erythematosus (SLE)Clinical Rheumatology, 2007
- Diagnosis and management of preeclampsia and eclampsiaInternational Journal of Gynecology & Obstetrics, 2002
- Repeated Pregnancies in Patients with Non-Immunoglobulin A Mesangioproliferative GlomerulonephritisAmerican Journal of Nephrology, 2001
- Pregnancy in past or present lupus nephritis: a study of 32 pregnancies from a single centreAnnals Of The Rheumatic Diseases, 2001