Selected renal diseases in pregnancy


Authors: O. Zakiyanov 1,2;  J. Vachek 1,3;  V. Tesař 1
Authors‘ workplace: Klinika nefrologie VFN a 1. LF UK v Praze 1;  Ústav lékařské biochemie a laboratorní diagnostiky VFN a 1. LF UK v Praze 2;  Farmakologický ústav 1. LF UK v Praze 3
Published in: Kardiol Rev Int Med 2014, 16(1): 67-73
Category: Internal Medicine

Overview

Kidney disease and pregnancy may exist in two general settings:
acute kidney injury that develops during pregnancy, and chronic kidney disease that predates conception. In the first trimester of pregnancy, acute kidney injury is most often the result of hyperemesis gravidarum, ectopic pregnancy, or miscarriage. In the second and third trimesters, the common causes of acute kidney injury are severe preeclampsia; haemolysis, elevated liver enzymes and low platelets syndrome; acute fatty liver of pregnancy; and thrombotic microangiopathies, which may pose diagnostic challenges to the clinician. Cortical necrosis and obstructive uropathy are other conditions that may lead to acute kidney injury in these trimesters. Early recognition of these disorders is essential to timely treatment and can improve both maternal and foetal outcomes. In women with preexisting kidney disease, mainly including chronic glomerulonephritis diabetic nephropathy and lupus nephritis, pregnancy‑related outcomes depend upon the degree of renal impairment, the amount of proteinuria, and the severity of hypertension. In the majority of patients with mild renal function impairment, and well‑controlled blood pressure, pregnancy is usually successful and does not alter the natural course of maternal renal disease. Conversely, fetal outcome and long‑term maternal renal function might be seriously threatened by pregnancy in women with moderate or severe renal function impairment. During the last few years, advances in our knowledge about the interaction of pregnancy and renal function has resulted in the improvement of foetal outcome in patients with chronic renal failure and also in the management of pregnant women with end‑stage renal disease (ESRD) maintained on dialysis. Neonatal and maternal outcomes in pregnancies among renal transplant patients are generally good if the mother has normal baseline allograft function. Common renally active drugs and immunosuppressant medications must be prescribed, with special considerations in pregnant patients.

Keywords:
chronic kidney disease –  acute renal injury –  pregnancy –  preeclampsia –  dialysis –  transplantation –  proteinuria – hypertension


Sources

1. Lindheimer MD, August P. Aldosterone, maternal volume status and healthy pregnancies: a cycle of differing views. Nephrol Dial Transplant 2009; 24: 1712– 1714. doi: 10.1093/ ndt/ gfp093.

2. Lindheimer MD, Katz AI. Hypertension in pregnancy: advances and controversies. Clin Nephrol 1991; 36: 166– 173.

3. Lindheimer MD, Davison JM, Katz Al. The kidney and hypertension in pregnancy: twenty exciting years. Semin Nephrol 2001; 21: 173– 189.

4. Vachek J, Tesař V, Zakiyanov O et al. Farmakoterapie v těhotenství a při kojení. Praha: Maxdorf; 2013.

5. Strevens H, Wide‑ Swensson D, Hansen A et al. Glomerular endotheliosis in normal pregnancy and pre‑eclampsia. BJOG 2003; 110: 831– 836.

6. Geller DS, Farhi A, Pinkerton N et al. Activating mineralocorticoid receptor mutation in hypertension exacerbated by pregnancy. Science 2000; 289: 119– 123.

7. Lindheimer MD, Katz AI. Preeclampsia: patho­physiology, dia­gnosis, and management. Annu Rev Med 1989; 40: 233– 250.

8. Maynard SE, Min JY, Merchan J et al. Excess placental soluble fms‑like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003; 111: 649– 658.

9. Odendaal HJ, Pattinson RC, Bam R et al. Aggres­sive or expectant management for patients with severe preeclampsia between 28– 34 weeks' gestation: a randomized controlled trial. Obstet Gynecol 1990; 76: 1070– 1075.

10. Doporučené postupy v perinatologii. Dostupné z: http:/ / lekari.porodnice.cz/ doporucene‑ postupy‑ v‑ perinatologii. [online].

11. Davison JM, Katz AI, Lindheimer MD. Kidney di­sease and pregnancy: obstetric outcome and long‑term renal prognosis. Clin Perinatol 1985; 12: 497– 519.

12. Minakami H, Morikawa M, Yamada T et al. Differentiation of acute fatty liver of pregnancy from syndrome of hemolysis, elevated liver enzymes and low platelet counts. J Obstet Gynaecol Res 2014. doi: 10.1111/ jog.12282.

13. Gyamlani G, Geraci SA. Kidney disease in pregnancy: (Women's Health Series). South Med J 2013; 106: 519– 525.

14. Nwoko R, Plecas D, Garovic VD. Acute kidney injury in the pregnant patient. Clin Nephrol 2012; 78: 478– 486.

15. Lo JO, Kerns E, Rueda J et al. Minimal change disease in pregnancy. J Matern Fetal Neonatal Med 2013.

16. Aoshima Y, Iyoda M, Nakazawa A et al. Membranous nephropathy that first presented in pregnancy. Intern Med 2013; 52: 1949– 1952.

17. Saxena I, Kapoor S, Gupta RC. Detection of proteinuria in pregnancy: comparison of qualitative tests for proteins and dipsticks with urinary protein creatinine index. J Clin Dia­gn Res 2013; 7: 1846– 1848.

18. Yamada T, Kojima T, Akaishi R et al. Problems in methods for the detection of significant proteinuria in pregnancy. J Obstet Gynaecol Res 2014; 40: 161– 166. doi: 10.1111/ jog.12148.

19. Kandukurti K, Sun J, Venuto R. Multiple pathologies in the kidney bio­psy of a recently pregnant woman. Case Rep Nephrol Urol 2013; 3: 9– 15. doi: 10.1159/ 000346862.

20. Piccoli GB, Daidola G, Attini R et al. Kidney bio­psy in pregnancy: evidence for counselling? A systematic narrative review. BJOG 2013; 120: 412– 427. doi: 10.1111/ 1471– 0528.12111.

21. Vellanki K. Pregnancy in chronic kidney disease. Adv Chronic Kidney Dis 2013; 20: 223– 228. doi: 10.1053/ j.ackd.2013.02.001.

22. Peart E, Clowse ME. Systemic lupus erythematosus and pregnancy outcomes: an update and review of the literature. Curr Opin Rheumatol 2014; 26: 118– 123. doi: 10.1097/ BOR.0000000000000030.

23. Lateef A, Petri M. Managing lupus patients during pregnancy. Best Pract Res Clin Rheumatol 2013; 27: 435– 447. doi: 10.1016/ j.berh.2013.07.005.

24. Piccoli GB, Clari R, Ghiotto S et al. Type 1 diabetes, diabetic nephropathy, and pregnancy: a systematic review and meta‑study. Rev Diabet Stud 2013; 10: 6– 26. doi: 10.1900/ RDS.2013.10.6.

25. Damm JA, Asbjörnsdóttir B, Callesen NF et al. Diabetic nephropathy and microalbuminuria in pregnant women with type 1 and type 2 diabetes: prevalence, antihypertensive strategy, and pregnancy outcome. Diabetes Care 2013; 36: 3489– 3494. doi: 10.2337/ dc13– 1031.

26. Bili E, Tsolakidis D, Stangou S et al. Pregnancy management and outcome in women with chronic kidney disease. Hippokratia 2013; 17: 163– 168.

27. Sivasuthan G, Dahwa R, John GT et al. Dialysis and pregnancy in end stage kidney disease associated with lupus nephritis. Case Rep Med 2013; 2013: 923581. doi: 10.1155/ 2013/ 923581.

28. Jesudason S, Grace BS, McDonald SP. Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clin J Am Soc Nephrol 2014; 9: 143– 149. doi: 10.2215/ CJN.03560413.

29. El Minshawy O, Ghabrah T, El Bassuoni E. End‑stage renal disease in Tabuk Area, Saudi Arabia: An epidemiological study. Saudi J Kidney Dis Transpl 2014; 25: 192– 195.

30. Wyld ML, Clayton PA, Jesudason S et al. Pregnancy outcomes for kidney transplant recipients. Am J Transplant 2013; 13: 3173– 3182. doi: 10.1111/ ajt.12452.

31. French VA, Davis JS, Sayles HS et al. Contraception and fertility awareness among women with solid organ transplants. Obstet Gynecol 2013; 122: 809– 814. doi: 10.1097/ AOG.0b013e3182a5eda9.

Labels
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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