Pregnancy in Patients with Chronic Renal Insufficiency at Hospital de Clínicas of Porto Alegre, Brazil

Abstract

Chronic renal insufficiency (CRI) decreases reproductive capability. The biggest challenge in monitoring pregnant women with renal disease is to keep the intrauterine environment favorable to the fetus. One of the common prognosis in this kind of pregnancy involves premature birth, restricted growth and mental retardation. Also, the risk of developing complications is higher for the mother. This study focuses on evaluating CRI patients' clinical conditions during pregnancy, checking fetal development and birth and verifying the prevalence of CRI in pregnant women attended at Hospital de Clínicas of Porto Alegre-Brazil (HCPA). This is a retrospective study with both a control and an case group of pregnant women with CRI who delivered their babies at HCPA from 1989 to 1999. The case group is composed of pregnant women with CRI, while the control group was paired according to maternal and gestational ages and to the time of the delivery, which should be the same both in the experimental and in the control group. Among the criteria usually used to identify CRI, we chose the creatinine level higher than 1.5 mg/dL. Significance was established in 0.05%. Our results demonstrate that the prevalence of CRI was 6/10,000 births. Average maternal age was 28. Sixty five per cent of the patients, in both the groups, underwent prenatal monitoring, 40% presented preeclampsia, 48% presented urinary infection. Among the CRI complications, 48% of the cases presented anemia and 56% presented systemic hypertension. Average hematocrit was 24% while hemoglobin was 6.7 g/dL, which leads us to the conclusion that patients presented anemia during pregnancy. Average creatinine was 4.61 mg/dL. It is relevant that 64% of the CRI cases migrated to a substitutive renal therapy method. As for the fetus evolution in the case group, we confirmed the findings of previous studies, such as larger number of premature births (newborns younger than 36 weeks in 60% of the cases), larger number of cesarean section (56%), lower weight at birth (1980 gr. in average), lower APGAR scores in the first and fifth minute (4.13 and 5.08, respectively) in comparison to the control group (7.52 and 8.63, respectively). We can state that babies born from CRI patients present underdevelopment. Also, mothers with CRI develop more complications during pregnancy.

A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy

“…Of the 23 studies (n=505,759 pregnancies), 14 (17)(18)(19)(20)(21)(22)27,28,30,32,33,35,37) of the reported adverse maternal or fetal outcomes in pregnant women with CKD. The definition of CKD varied across the studies.…”

“…The overall preeclampsia OR was 10.36 (95% CI, 6.28 to 17.09; P,0.01; Figure 2) in women with CKD compared with women without CKD. Ten studies (2,17,(19)(20)(21)27,28,32,33,35) reported 25,273 failures of pregnancy among 505,038 pregnancies. Compared with the controls, patients with CKD with pregnancy had a significantly higher rate of pregnancy failure (OR, 1.80; 95% CI, 1.03 to 3.13; P=0.04; Figure 3).…”

“…Among 23 retrieved studies, 12 (17)(18)(19)(20)(21)(22)24,25,30,32,33) were prospective studies, 7 (24)(25)(26)(27)(28)(29)31,35,37) were retrospective studies, and 4 (23,25,34,36) did not mention whether they were retrospective or prospective. Twelve studies were from European countries, five were from the United States, four were from Asia, and two were from Brazil.…”

“…Among 14 studies, 8 (17)(18)(19)(20)(21)(22)30,32) enrolled patients diagnosed with diabetic nephropathy (DN) with proteinuria, 3 (33,37) defined CKD according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative definition, 1 defined CKD according to by medical coding (27), and 1 defined CKD by biopsy (35). One study (28) enrolled pregnant women with low kidney LGA, large for gestational age; IUGR, intrauterine growth restriction;…”

“…Nine studies (18)(19)(20)(21)(22)27,28,32,37) evaluated the occurrence of preeclampsia. Overall, there were 14,993 events in 504,700 pregnancies.…”