Selected renal diseases in pregnancy

Czech version

Authors: O. Zakiyanov ^1,2; J. Vachek ^1,3; V. Tesař ¹
Authors‘ workplace: Klinika nefrologie VFN a 1. LF UK v Praze ¹; Ústav lékařské biochemie a laboratorní diagnostiky VFN a 1. LF UK v Praze ²; Farmakologický ústav 1. LF UK v Praze ³
Published in: Kardiol Rev Int Med 2014, 16(1): 67-73
Category: Internal Medicine

Overview

Kidney disease and pregnancy may exist in two general settings:
acute kidney injury that develops during pregnancy, and chronic kidney disease that predates conception. In the first trimester of pregnancy, acute kidney injury is most often the result of hyperemesis gravidarum, ectopic pregnancy, or miscarriage. In the second and third trimesters, the common causes of acute kidney injury are severe preeclampsia; haemolysis, elevated liver enzymes and low platelets syndrome; acute fatty liver of pregnancy; and thrombotic microangiopathies, which may pose diagnostic challenges to the clinician. Cortical necrosis and obstructive uropathy are other conditions that may lead to acute kidney injury in these trimesters. Early recognition of these disorders is essential to timely treatment and can improve both maternal and foetal outcomes. In women with preexisting kidney disease, mainly including chronic glomerulonephritis diabetic nephropathy and lupus nephritis, pregnancy‑related outcomes depend upon the degree of renal impairment, the amount of proteinuria, and the severity of hypertension. In the majority of patients with mild renal function impairment, and well‑controlled blood pressure, pregnancy is usually successful and does not alter the natural course of maternal renal disease. Conversely, fetal outcome and long‑term maternal renal function might be seriously threatened by pregnancy in women with moderate or severe renal function impairment. During the last few years, advances in our knowledge about the interaction of pregnancy and renal function has resulted in the improvement of foetal outcome in patients with chronic renal failure and also in the management of pregnant women with end‑stage renal disease (ESRD) maintained on dialysis. Neonatal and maternal outcomes in pregnancies among renal transplant patients are generally good if the mother has normal baseline allograft function. Common renally active drugs and immunosuppressant medications must be prescribed, with special considerations in pregnant patients.

Keywords:
chronic kidney disease – acute renal injury – pregnancy – preeclampsia – dialysis – transplantation – proteinuria – hypertension

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