Enfermedad renal crónica en mujeres embarazadas
PDF

Palabras clave

insuficiencia renal crónica
mujeres embarazadas
tasa de filtración glomerular
diálisis

Cómo citar

1.
Pérez Calvo C, Rico Fontalvo J, Lavalle López O, Daza Arnedo R, Pájaro Galvis N, Monterrosa Robles M, Pérez Olivo J, Leal Martínez V, Abuabara Franco E, Benavides Arenas R, Cardona Blanco M, Uparella Gulfo I, Vengoechea Visbal M. Enfermedad renal crónica en mujeres embarazadas: Chronic kidney disease in pregnant women. Rev. Colomb. Nefrol. [Internet]. 11 de noviembre de 2020 [citado 21 de octubre de 2021];8(1):e518. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/518

Resumen

La enfermedad renal crónica (ERC), definida como una alteración estructural o funcional renal que persiste por más de 3 meses con o sin deterioro de la función renal o como un filtrado glomerular (FG) < 60 mL/min/1,73 m 2 sin otros signos de enfermedad renal, es una condición prevalente en la población general; sin embargo, no es tan frecuente en mujeres embarazadas. A pesar de su baja frecuencia en gestantes, el antecedente de enfermedad renal se asocia con peores desenlaces maternos y fetales cuando se presenta ERC. Las fórmulas estándar (CKD-EPI, Cockroft-Gault y MDRD) utilizadas para determinar la tasa de filtrado glomerular en población no obstétrica tienen poca precisión en las embarazadas debido a que subestiman la función renal en aproximadamente un 20 %. Ante esto, el aclaramiento de creatinina medido utilizando recolecciones de orina de 24 horas y la estimación de creatinina sérica que se correlaciona estrechamente con el aclaramiento de inulina (estándar de oro) son opciones que pueden utilizarse durante el embarazo. Asimismo, el reconocimiento temprano de la enfermedad, la optimización de las estrategias de nefroprotección, el evitar las drogas nefrotóxicas y la instauración de un tratamiento específico para la etiología garantizan una mayor sobrevida y un menor número de complicaciones derivadas de la enfermedad renal.

https://doi.org/10.22265/acnef.8.1.518
PDF

Citas

Hui D, Hladunewich MA. Chronic Kidney Disease and Pregnancy. Obstet Gynecol.2019;133(6):1182-94. https://dx.doi.org/10.1097/AOG.0000000000003256

Hladunewich MA. Chronic Kidney Disease and Pregnancy. Semin Nephrol. 2017;37(4):337-46. https://dx.doi.org/10.1016/j.semnephrol.2017.05.005

Chan CT, Blankestijn PJ, Dember LM, Gallieni M, Harris DCH, Lok CE,et al.Iniciación a ladiálisis, elección de modalidad, acceso y prescripción: conclusiones de Conferencia de Con-troversia de KDIGO (Kidney Disease Improving Glo- bal Outcomes). Kidney International.2019;96:37-47. https://dx.doi.org/10.1016/

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chro-nic Kidney Disease. O cial Journal of the International Society of Nephrology. 2013 [ci-tado agosto 29 de 2020];3(1). Disponible en: https://kdigo.org/wp-content/uploads/2017/02/KDIGO2012CKDGL.pdf

Hall M. Chronic renal disease and antenatal care. Best Pract Res Clin Obstet Gynaecol.2019;57:15-32. https://dx.doi.org/10.1016/j.bpobgyn.2018.10.002

Jones DC, Hayslett JP. Outcome of Pregnancy in Women with Moderate or Se-vere Renal Insu ciency. N Engl J Med. 1996335(4):226-32. https://dx.doi.org/10.1056/NEJM199607253350402

Koetje PMJL, Spaan JJ, Kooman JP, Spaanderman MEA, Peeters LL. Pregnancy Reduces theAccuracy of the Estimated Glomerular Filtration Rate Based on Cockroft-Gault and MDRDFormulas. Reprod Sci. 2011;18(5):456-62. https://dx.doi.org/10.1177/1933719110387831

GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chro-nic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-33. https://dx.doi.org/10.1016/S0140-6736(20)30045-3

Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS,et al. Global Pre-valence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One.2016;11(7):e0158765. https://dx.doi.org/10.1371/journal.pone.0158765

Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we know and do notknow about women and kidney diseases; Questions unanswered and answers unquestio-ned: Re ection on World Kidney Day and International Woman’s Day. Braz J Med Biol Res.2018;51(7):e7315. https://dx.doi.org/10.1590/1414-431x20177315

He Y, Liu J, Cai Q, Lv J, Yu F, Chen Q,et al. The pregnancy outcomes in patients with stage3-4 chronic kidney disease and the effects of pregnancy in the long-term kidney function. JNephrol. 2018;31(6):953-60. https://dx.doi.org/10.1007/s40620-018-0509-z

Fitzpatrick A, Mohammadi F, Jesudason S. Managing pregnancy in chronic kidney di-sease: improving outcomes for mother and baby. Int J Womens Health. 2016;8:273-85.https://dx.doi.org/10.2147/IJWH.S76819

Munkhaugen J, Lydersen S, Romundstad PR, Wideroe TE, Vikse BE, Hallan S. Kidneyfunction and future risk for adverse pregnancy outcomes: a population- based study fromHUNT II, Norway. Nephrol Dial Transplant. 2009;24(12):3744-50. https://dx.doi.org/10.1093/ndt/gfp320

Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;336(7637):211-5.https://dx.doi.org/10.1136/bmj.39406.652986.BE

Gonzalez-Suarez ML, Kattah A, Grande JP, Garovic V. Renal Disorders in Pregnancy: CoreCurriculum 2019. Am J Kidney Dis. 2019;73(1):119-30. https://dx.doi.org/10.1053/j.ajkd.2018.06.006

Rojas WG, Cantillo JJ, Cantillo MJ. Enfermedad renal crónica y embarazo. Un desafío enla atención clínica y desenlace obstétrico. Acta Médica Colomb. 2015;40(4):7

Tong A, Jesudason S, Craig JC, Winkelmayer WC. Perspectives on pregnancy in womenwith chronic kidney disease: systematic review of qualitative studies. Nephrol Dial Trans-plant. 2015;30(4):652-61. https://dx.doi.org/10.1093/ndt/gfu378

Piccoli GB, Cabiddu G, Attini R, Vigotti FN, Maxia S, Lepori N,et al.Risk of AdversePregnancy Outcomes in Women with CKD. J Am Soc Nephrol. 2015;26(8):2011-22. https://dx.doi.org/10.1681/ASN.2014050459

Ibarra-Hernández M, Jiménez-Alvarado PM, Albarrán-López P, Botello- Ramírez SA. En-fermedad renal crónica durante el embarazo. Revista Médica MD. 2015;6(2):119-25

Hladunewich MA, Vella J, August P. Pregnancy in women with nondialysis chronic kid-ney disease. UpToDate. 2020

Castellanos-Castillo Y, Fong-Estrada JA, Vázquez-Trigo JM, Fong JO. Marcadores de da-ño renal en pacientes con factores de riesgo de enfermedad renal crónica. MEDISAN.2018;22(2):142-8

Zuleta R, Gerado W. Enfermedad renal crónica y embarazo, descripción clínica y desen-lace obstétrico de una serie de casos. Bogotá D.C.: Universidad nacional de Colombia; 2015

Wu CC, Chen SH, Ho CH, Liang FW, Chu CC, Wang HY,et al.End-stage renal diseaseafter hypertensive disorders in pregnancy. Am J Obstet Gynecol. 2014;210(2):147.e1-8. https://dx.doi.org/10.1016/j.ajog.2013.09.027

Piccoli GB, Daidola G, Attini R, Parisi S, Fassio F, Naretto C,et al.Kidney biopsy in preg-nancy: evidence for counselling? A systematic narrative review. BJOG. 2013;120(4):412-27.https://dx.doi.org/10.1111/1471-0528.12111

Eswarappa M, Rakesh M, Sonika P, Snigdha K, Midhun M, Kaushik K,et al.Spectrumof renal injury in pregnancy-induced hypertension: Experience from a single center in In-dia. Saudi J Kidney Dis Transplant. 2017;28(2):279-84. https://dx.doi.org/10.4103/1319-2442.202790

Lopera-Medina MM. La enfermedad renal crónica en Colombia: necesidades en saludy respuesta del Sistema General de Seguridad Social en Salud. Rev. Gerenc. Polít. Salud.2016;15(30):212-33. https://dx.doi.org/10.11144/Javeriana.rgyps15-30.ercc

Krajewski CM, Geetha D, Gomez-Lobo V. Contraceptive Options for Women With a His-tory of Solid-Organ Transplantation. Transplantation. 2013;95(10):1183- 6. https://dx.doi.org/10.1097/TP.0b013e31827c64de

Holley JL, Schmidt RJ. Changes in Fertility and Hormone Replacement Therapy in KidneyDisease. Adv Chronic Kidney Dis. 2013;20(3):240-5. https://dx.doi.org/10.1053/j.ackd.2013.01.003

Piccoli GB, Cabiddu G, Attini R, Vigotti F, Fassio F, Rolfo A,et al.Pregnancy in ChronicKidney Disease: questions and answers in a changing panorama. Best Pract Res Clin ObstetGynaecol. 2015;29(5):625-42. https://dx.doi.org/10.1016/j.bpobgyn.2015.02.005

Mol BWJ, Roberts CT, Thangaratinam S, Magee LA, de Groot CJM, Hofmeyr GJ.Pre-eclampsia. Lancet. 2016;387(10022):999-1011. https://dx.doi.org/10.1016/S0140-6736(15)00070-7

Magee LA, von Dadelszen P, Rey E, Ross S, Asztalos E, Murphy KE,et al.Less-Tight versusTight Control of Hypertension in Pregnancy. N Engl J Med. 2015;372(24):407-17.https://dx.doi.org/10.1056/NEJMoa1404595

Khaing W, Vallibhakara SAO, Tantrakul V, Vallibhakara O, Rattanasiri S, McEvoy M,etal.Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A SystematicReview and Network Meta-Analysis. Nutrients. 2017;9(10):1141. https://dx.doi.org/10.3390/nu9101141

Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco-Matallana C, et al.Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl JMed. 2017;377(7):613-22. https://dx.doi.org/10.1056/NEJMoa1704559

Piccoli GB, Fassio F, Attini R, Parisi S, Biolcati M, Ferraresi M,et al.Pregnancy in CKD:whom should we follow and why? Nephrol Dial Transplant. 2012;27(suppl 3):iii111-8. https://dx.doi.org/10.1093/ndt/gfs302

Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A,et al. Preg-nancy in CKD Stages 3 to 5: Fetal and Maternal Outcomes. Am J Kidney Dis. 2007;49(6):753-62. https://dx.doi.org/10.1053/j.ajkd.2007.03.022

Onder S, Akbar S, Schmidt RJ. Reproductive Endocrinology in Chronic Kidney DiseasePatients: New Approaches to Old Challenges. Semin Dial. 2016;29(6):447-57. https://dx.doi.org/10.1111/sdi.12528

Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney diseaseand kidney transplantation. Kidney Int. 2017;91(5):1047-56. https://dx.doi.org/10.1016/j.kint.2016.10.045

and Sau A, Clarke S, Bass J, Kaiser A, Marinaki A, Nelson-Piercy C. Azathioprine breast-feeding: is it safe? BJOG. 2007;114(4):498-501. https://dx.doi.org/10.1111/j.1471-0528.2006.01232.x

Bramham K, Chusney G, Lee J, Lightstone L, Nelson-Piercy C. Breastfeeding and Ta-crolimus: Serial Monitoring in Breast-Fed and Bottle-Fed Infants. Clin J Am Soc Nephrol.2013;8(4):563-7. https://dx.doi.org/10.2215/CJN.06400612

Hoeltzenbein M, Elefant E, Vial T, Finkel-Pekarsky V, Stephens S, Clementi M,et al.Tera-togenicity of mycophenolate con rmed in a prospective study of the European Network ofTeratology Information Services. Am J Med Genet A. 2012;158A(3):588-96. https://dx.doi.org/10.1002/ajmg.a.35223

Anderka MT, Lin AE, Abuelo DN, Mitchell AA, Rasmussen SA. Reviewing the evidencefor mycophenolate mofetil as a new teratogen: Case report and review of the literature. AmJ Med Genet A. 2009;149A(6):1241-8. https://dx.doi.org/10.1002/ajmg.a.32685

Clowse MEB, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arth-ritis Rheum. 2006;54(11):3640-7. https://dx.doi.org/10.1002/art.22159

Sebestyen A, Varbiro S, Sara L, Deak G, Kerkovits L, Szabo I,et al.Successful Managementof Pregnancy with Nephrotic Syndrome due to Preexisting Membranous Glomerulonephri-tis: A Case Report. Fetal Diagn Ther. 2008;24(3):186- 9. https://dx.doi.org/10.1159/000151336

Barbour SJ, Greenwald A, Djurdjev O, Levin A, Hladunewich MA, Nachman PH,et al.Disease-speci c risk of venous thromboembolic events is increased in idiopathic glomeru-lonephritis. Kidney Int. 2012;81(2):190-5. https://dx.doi.org/10.1038/ki.2011.312

Neeland IJ, Salahuddin U, McGuire DK. A Safety Evaluation of Empagli ozin for theTreatment of Type 2 Diabetes. Expert Opin Drug Saf. 2016;15(3):393-402. https://dx.doi.org/10.1517/14740338.2016.1135900

Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from1966-2008, examining pregnancy and neonatal outcomes from dialysed women using datafrom the ANZDATA Registry: Nephrology (Carlton). 2013;18(4):276-84. https://dx.doi.org/10.1111/nep.12044

Piccoli GB, Minelli F, Versino E, Cabiddu G, Attini R, Vigotti FN,et al.Pregnancyin dialysis patients in the new millennium: a systematic review and meta- regressionanalysis correlating dialysis schedules and pregnancy outcomes. Nephrol Dial Transplant.2016;31(11):1915-34. https://dx.doi.org/10.1093/ndt/gfv395

Hladunewich MA, Hou S, Odutayo A, Cornelis T, Pierratos A, Goldstein M,et al.Intensi-ve Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison. J Am Soc Nephrol. 2014;25(5):1103-9. https://dx.doi.org/10.1681/ASN.2013080825

Hladunewich MA, August P, Vella J. Pregnancy in women on dialysis. UpToDate. 2020

Tangren J, Nadel M, Hladunewich MA. Pregnancy and End-Stage Renal Disease. BloodPurif. 2018;45(1-3):194-200. https://doi.org/10.1159/000485157

McKay DB, Josephson MA. Pregnancy in Recipients of Solid Organs — Effects on Mot-her and Child. N Engl J Med. 2006;354(12):1281-93. https://dx.doi.org/10.1056/NEJMra050431

Wyld ML, Clayton PA, Jesudason S, Chadban SJ, Alexander SI. Pregnancy Outcomes forKidney Transplant Recipients. Am J Transplant. 2013;13(12):3173- 82. https://dx.doi.org/10.1111/ajt.12452

Kim H, Jeong JC, Yang J, Yang WS, Ahn C, Han DJ,et al.The optimal therapy of calcineu-rin inhibitors for pregnancy in kidney transplantation. Clin Transplant. 2015;29(2):142-8.https://dx.doi.org/10.1111/ctr.12494

Sifontis NM, Coscia LA, Constantinescu S, Lavelanet AF, Moritz MJ, Armenti VT. Preg-nancy Outcomes in Solid Organ Transplant Recipients With Exposure to Mycopheno-late Mofetil or Sirolimus. Transplantation. 2006;82(12):1698-702. https://dx.doi.org/10.1097/01.tp.0000252683.74584.29

Rao S, Ghanta M, Moritz MJ, Constantinescu S. Long-Term Functional Recovery, Qua-lity of Life, and Pregnancy After Solid Organ Transplantation. Med Clin North Am.2016;100(3):613-29. https://dx.doi.org/10.1016/j.mcna.2016.01.010

Deshpande NA, James NT, Kucirka LM, Boyarsky BJ, Garonzik-Wang JM, Montgo-mery RA,et al.Pregnancy Outcomes in Kidney Transplant Recipients: A Systematic Re-view and Meta-Analysis. Am J Transplant. 2011;11(11):2388-404. https://dx.doi.org/10.1111/j.1600-6143.2011.03656.x

Josephson MA, McKay DB. Pregnancy and Kidney Transplantation. Semin Nephrol.2011;31(1):100-10. https://dx.doi.org/10.1016/j.semnephrol.2010.10.009

Durán-Alcaraz CL, Reyes-Paredes N. Enfermedades renales y embarazo. Rev Hosp GralDr M Gea González. 2006;7(2):82-9.

Díaz JPO, Hernández RC, Mayo JD, Rodríguez RAO, Pérez RT. Diagnóstico, Evaluación yManejo de la Enfermedad Renal en el Embarazo. Rev Haban Cienc Méd. 2016;15(5):834-58.

Zhang JJ, Ma XX, Hao L, Liu LJ, Lv JC, Zhang H. A Systematic Review and Meta-Analysisof Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy. Clin J Am Soc Neph-rol. 2015;10(11):1964-78. https://dx.doi.org/10.2215/CJN.09250914

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.

Derechos de autor 2020 Revista Colombiana de Nefrología

Descargas

Los datos de descargas todavía no están disponibles.