Pregnancy in Women with Chronic Renal Failure

Abstract

We describe 19 pregnancies in 18 women with chronic renal disease and plasma creatinine ≥1.6 mg/dl before pregnancy. There were 2 spontaneous abortions (11th and 21st week), 2 therapeutic abortions (18th and 19th week), 1 stillbirth (30th week), 1 neonatal death (31st week) and 13 live births, 7 of them were preterm. Nine cesarean sections were done. Serial determinations of plasma creatinine during pregnancy showed a trend to decrease during the first half and to increase during the second half of pregnancy. The effect of pregnancy on the progression of renal failure was evaluated in 14 patients by comparing the linear regression lines of reciprocal plasma creatinine versus time before and after pregnancy. In 5 patients the rate of progression worsened after pregnancy. Our data indicate that women with chronic renal failure may have a successful pregnancy, but one third of them will have an accelerated rate of progression of the disease.

Successful Pregnancy in a Patient with Polycystic Kidney Disease and Advanced Renal Failure without Prophylactic Dialysis

“…These pregnancies are frequently associated with a progressive decline in renal function that may result in end-stage renal failure even in female patients whose serum creatinine are mildly elevated at the start of their pregnancy [4, 5, 6, 7]. For example, Jones and Hayslett [7]reported that the mean serum creatinine increased from 1.9 ± 0.8 mg/dl (168 ± 71 µmol/l) in the first trimester of pregnancy to 2.5 ± 1.3 mg/dl (221 ± 115 µmol/l) in third trimester (p < 0.001).…”

“…Although prospective data are not available, it is probable that strict control of hypertension during pregnancy would have protective effects on the kidney as has been demonstrated in nonpregnant women [15]. Birth weights and fetal survival rates are lower in pregnant hypertensive women than in pregnant normotensive women [4, 5, 6, 9, 16, 17, 18]. This emphasizes the importance of controlling blood pressure during pregnancy in order to preserve the maternal renal function and improve the fetal outcome.…”

“…When pregnancy occurs in such women, their renal function further deteriorates and their hypertension is usually exacerbated [4, 5, 6, 7]. Pregnancies in these women are associated with a high frequency of premature births of infants with low birth weights [3, 4, 7, 8, 9].…”

Pregnancy and Renal Disease: Predictors for Fetal and Maternal Outcome

“…Three studies have been specifically devoted to preg nancy in women with chronic renal failure [61][62][63]. They cumulatively include 81 pregnancies in 78 women with serum creatinine > 1 .4 mg/dl at conception (table 4).…”

Successful Delivery in a Patient with Antineutrophil Cytoplasmic Antibody-associated Glomerulonephritis

“…Therefore, pregnancy in patients with ANCA-associated glomerulonephritis is rare, and information regarding the management of ANCA-associated glomerulonephritis during pregnancy is limited. Moreover, pregnancy in patients with a low estimated glomerular filtration rate (eGFR) for any reason accelerates declines in the kidney function accompanied with a high rate of obstetrical complications (1)(2)(3)(4)(5)(6)(7)(8).…”