Keywords
pregnant women
glomerular filtration rate
dialysis
How to Cite
Abstract
Chronic Kidney Disease, defined as a renal structural or functional alteration that persists for more than 3 months, with or without deterioration of renal function, or a glomerular filtration rate (GFR) < 60 ml / min / 1.73 m2 without other signs of Kidney disease is a prevalent condition in the general population, however, it is not so common to find it in pregnant women. However, a history of kidney disease is associated with worse maternal and fetal outcomes. The standard formulas (CKD-EPI, Cockroft-Gault, and MDRD) used in the non-obstetric population have poor precision in determining glomerular filtration rate, because they underestimate kidney function by approximately 20 %. Creatinine clearance measured using 24-hour urine collections and serum creatinine estimate closely correlates with inulin clearance ("gold standard") and can be used during pregnancy. Early recognition of the disease, optimization of nephroprotection strategies, avoiding nephrotoxic drugs and specific treatment of the etiology, will guarantee a longer survival and fewer complications derived from kidney disease.
References
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
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2020 Revista Colombiana de Nefrología