Chronic renal disease in pregnancy; a modern approach to predicting outcome

Modena, Alisa; Hoffman, Matthew; Tolosa, Jorge E.

doi:10.1016/j.ajog.2005.10.572

Cited by 7 publications

(4 citation statements)

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“…Consequently, advice should be based on the degree of renal function and not on the underlying parenchymal lesion, although certain disorders (mainly systemic in nature) may have poorer prognoses. In a recent survey of 120 000 birth records, Modena et al [17] identified 82 women with chronic renal disease. Using logistic regression and receiver operating characteristic analysis, they confirmed that an Scr ≤ 1.4 mg/dL (≤124 µmol/L) was associated with live birth outcomes similar to those of the pregnant population as a whole, but a cut-off value of 1.1 mg/dL (97 µmol/L) was associated with an increase in preterm delivery.…”

Section: Discussionmentioning

confidence: 98%

Chronic kidney disease in pregnancy requiring first‐time dialysis

Sato

Oliveira

Kirsztajn

et al. 2010

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 98%

Chronic kidney disease in pregnancy requiring first‐time dialysis

Sato

Oliveira

Kirsztajn

et al. 2010

Intl J Gynecology & Obste

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“…The value of 70 mol/l was used to screen for renal insufficiency in the current study. The incidence of chronic renal disease in pregnancy is generally neglected as being low, ranging between 0.002 and 0.01% in various studies [12,[14][15][16] . However, in the current study, the incidence of renal insufficiency during pregnancy was nearly 2.51%.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Study of Pregnancy-Associated Renal Insufficiency

Wang

Xing²,

Wang³

et al. 2010

Kidney Blood Press Res

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Background/Aim: This study aimed to explore the causes, incidence and outcome of renal insufficiency during pregnancy. Methods: All pregnant women admitted to our hospital from September 2004 to August 2007 were retrospectively screened for renal function. Patients were divided into 3 groups according to the serum creatinine (Scr) level (mild renal insufficiency: Scr 70–123 µmol/l; moderate: Scr 124–220 µmol/l; severe: Scr >221 µmol/l). Results: Seventy-five cases (2.51%) of renal insufficiency were identified. Twenty-two cases (0.73%) had evidence of chronic kidney disease before pregnancy. Compared to the moderate and severe groups, the mild group had the lowest blood pressure. In 29 recorded cases with multiple observations throughout pregnancy, the deterioration of renal function progressed during the course of pregnancy; on average, Scr changed from 177 ± 109 µmol/l in the early phase of pregnancy to 194 ± 149 µmol/l (p < 0.001) in the third trimester, and mean blood pressure increased from 97 ± 11 to 120 ± 19 mm Hg (p < 0.001). There were 37 cases with preeclampsia (49%). Fourteen cases showed a decrease in glomerular filtration rate (GFR) in the third trimester; 4 of these patients suffered a severe decrease in GFR (over 25%). The rate of obstetrical complications was high among pregnancies with renal impairment. Conclusion: Renal insufficiency associated with pregnancy is not rare, and renal function may deteriorate during the course of pregnancy.

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“…Interestingly, as in our series, the differences with the overall population were also observed for mild degrees of renal function impairment, with minor differences in the risk of adverse perinatal outcome in women with severe CKD compared with milder disease. However, because in our population no neonatal or perinatal death occurred, the mathematical model proposed by the authors was not applicable in our context (45,46) In our study, because of the absence of such hard end points, surrogate end points were studied, including cesarean section, preterm delivery, SGA, and need for NICU admission. All of the surrogate outcomes except SGA are closely correlated with the presence of CKD; this holds true for all cases and for the stage 1 CKD patients versus controls (Tables 4 to 6).…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and Chronic Kidney Disease

Piccoli

Attini

Vasario

et al. 2010

Clinical Journal of the American Society of Nephrology

193

158

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Background and objectives: Chronic kidney disease (CKD) is a challenge for pregnancy. Its recent classification underlines the importance of its early phases. This study's 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. 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.

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Chronic renal disease in pregnancy; a modern approach to predicting outcome

Cited by 7 publications

References 0 publications

Chronic kidney disease in pregnancy requiring first‐time dialysis

Chronic kidney disease in pregnancy requiring first‐time dialysis

A Clinical Study of Pregnancy-Associated Renal Insufficiency

Pregnancy and Chronic Kidney Disease

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