Chronic Kidney Disease and Pregnancy: A Review of the Literature
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Aug 28, 2023
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Derlly Marcela Espitia Orejarena
Maria Camila Montero Acuña
https://orcid.org/0000-0002-7447-9304
Érika Tatiana Nasner Posso
https://orcid.org/0000-0002-2734-2145
María Cristina Suárez Gómez
https://orcid.org/0000-0002-7447-9304
Érika Tatiana Nasner Posso
https://orcid.org/0000-0002-2734-2145
María Cristina Suárez Gómez
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Abstract
Chronic kidney disease in pregnancy is a poorly studied entity due to the few studies on the subject. This pathology is related to both fetal and maternal outcomes with a worse prognosis. Kidney disease in pregnant women can be divided into three scenarios, the first encompasses acute kidney disease, the second patients with undiagnosed chronic kidney disease and the last when it is already established previously and which will be discussed in this article. Mothers who present this entity in very advanced stages are going to be more likely to have worse perinatal and neonatal outcomes, so it is of great importance to know the stage prior to pregnancy and to carry out continuous and rigorous monitoring of their renal function. so that risks can be reduced or attempted to be mitigated. The treatment is going to be based on reducing the adverse effects and on the follow-up of the parameters that are carried out in the preconception consultation. The objective of this review is to acquire greater knowledge and update the reader on patients with chronic kidney disease and pregnancy; as well as to know in a deeper way its possible complications and outcomes, both maternal and fetal.
Keywords
Embarazo, enfermedad renal, fisiologia, funcion renalpregnancy, kidney disease, physiology, kidney function
References
1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266. PMID: 11904577.
2. Smyth A, Radovic M, Garovic VD. Women, kidney disease, and pregnancy. Adv Chronic Kidney Dis. 2013 Sep;20(5):402-10. https://doi.org/10.1053/j.ackd.2013.06.004
3. Choi C-Y, Cho N-J, Park S, Gil HW, Kim Y-S, Lee EY. A case report of successful pregnancy and delivery after peritoneal dialysis in a patient misdiagnosed with primary infertility. Medicine (Baltimore). 2018 Jun;97(26):e11148.
4. Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007 Jun;49(6):753-62. https://doi.org/10.1053/j.ajkd.2007.03.022
5. Jungers P, Chauveau D, Choukroun G, Moynot A, Skhiri H, Houillier P, Forget D, Grünfeld JP. Pregnancy in women with impaired renal function. Clin Nephrol. 1997 May;47(5):281-8.
6. Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996;335(10):226-32.
7. Davison J, Baylis C. Renal disease. En: De Swiet M, editor. Medical disorders in obstetric practice. 3.ª ed. Oxford: Blackwell Science; 1995. p. 226-305.
8. Guillén AO. Enfermedad renal crónica y embarazo. Acta Médica Grupo Angeles. 2018;16(S1):41-46.
9. Pérez Calvo C, Rico Fontalvo J, Lavalle López O, Daza Arnedo R, Pájaro Galvis N, Monterrosa Robles M, Vengoechea Visbal M. Enfermedad renal crónica en mujeres embarazadas. Rev Colomb Nefrol. 2021;8(1).
10. Pérez-Oliva Díaz J, Cantero Hernández R, Díaz Mayo J, Oviedo Rodríguez RA, Tamayo Pérez R. Diagnóstico, evaluación y manejo de la enfermedad renal en el embarazo: diagnóstico, evaluación y manejo de enfermedades renales durante el embarazo. Rev Haban Cienc Méd. 2016;15(5):834-58.
11. Gorostidi M, Santamaría R, Alcázar R, Fernández-Fresnedo G, Galcerán JM, Goicoechea M, Ruilope LM. Documento de la Sociedad Española de Nefrología sobre las guías KDIGO para la evaluación y el tratamiento de la enfermedad renal crónica. Nefrología (Madrid). 2014;34(3):302-16.
12. Bikbov B, Purcell C A, Levey A S, Smith M, Abdoli A, Abebe M, Owolabi MO. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-33.
13. Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FR. Global prevalence of chronic kidney disease-a systematic review and meta-analysis. PloS One. 2016;11(7):e0158765. https://doi.org/10.1371/journal.pone.0158765
14. Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A, World Kidney Day Steering Committee. What we do and do not know about women and kidney diseases: questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman’s Day. Physiol Int. 2018;105(1):1-18.
15. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chronic Kidney Dis. 2007;14(2):132-45.
16. Fitzpatrick A, Mohammadi F, Jesudason S. Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby. Int J Womens Health. 2016:273-85. https://doi.org/10.2147/IJWH.S76819
17. Carrillo-Mora P, García-Franco A, Soto-Lara M, Rodríguez-Vásquez G, Pérez-Villalobos J, Martínez-Torres D. Physiological changes during a normal pregnancy. Rev Fac Med UNAM. 2021;64(1):39-48.
18. Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013;20(3):209-14.
19. Williams D, Davison J. Chronic kidney disease in pregnancy. Br Med J. 2008;336(7637):211-15. https://doi.org/10.1136/bmj.39406.652986.BE
20. Wiles K S, Nelson-Piercy C, Bramham K. Reproductive health and pregnancy in women with chronic kidney disease. Nat Rev Nephrol. 2018;14(3):165-84.
21. González AO. Embarazo y riñón. Galicia: Servicio de Nefrología, CH Universitario de Ourense; 2020.
22. Bernasconi AR. Riñón y embarazo. II: glomerulopatías y embarazo. Rev Electron Biomed [internet]. 2016;(3):27-32. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=8883947
23. Aguirre Ospina OD, Buitrago CA. Enfermedad renal en la paciente obstétrica. En: Nefrología básica 2 [internet]. Asociación Colombiana de Nefrología; s. f. 357-70. Disponible en: https://asocolnef.com/libro-de-nefrologia-basica-2/
24. Hladunewich MA, Melamed N, Bramham K. Pregnancy across the spectrum of chronic kidney disease. Kidney Int. 2016 May;89(5):995-1007. https://doi.org/10.1016/j.kint.2015.12.050
25. Polanco NA, Gutiérrez KA, Morales NC. El embarazo en una paciente con enfermedad renal crónica en hemodiálisis: a propósito de un caso y revisión de la literatura. Diál Trasplant. 2015;36(1):34-9.
26. Piccoli GB, Cabiddu G, Attini R, Vigotti F N, Maxia S, Lepori N, Todros T. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol. 2015;26(8):2011-22.
27. Chinnappa V, Ankichetty S, Angle P, Halpern S. H. Chronic kidney disease in pregnancy. Int J Obst Anesth. 2013;22(3):223-30.
28. Kendrick J, Sharma S, Holmen J, Palit S, Nuccio E, Chonchol M. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015;66(1):55-9.
29. Merino JL, Espejo B, Ferreiro P, Bueno B, Paraíso V. Gestación en enfermedad renal crónica avanzada. Nefrología (Madrid). 2010;30(3):376-8.
30. Rojas-Rodríguez FO, Pérez-López MJ, Paniagua-Sierra R, Vázquez-Vega B, Chinolla-Arellano ZL, Zárate-González J, Juan-Carlos HR. Desenlaces clínicos en mujeres embarazadas en estadio I de la clasificación KDIGO comparado con mujeres sin enfermedad renal. Gac Méd Bilbao. 2020;117(1):28-34.
31. Manterola-Álvarez D, Hernández-Pacheco JA, Estrada-Altamirano A. Enfermedad renal crónica durante el embarazo: curso clínico y resultados perinatales en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Perinatol Reprod Hum. 2012;26(4):147-53.
32. Rojas WG, Cantillo JDJ, Cantillo MJ. Chronic renal disease and pregnancy: a challenge in clinical care and obstetric outcome. Acta Med Colomb. 2015;40(4):318-25.
33. Montaña A, Patiño N, Larrate C, Zambrano F A, Martínez J, Lozano H, Lozano E. Actualización en enfermedad renal poliquística. Rev Fac Med. 2018;66(1):107-16.
34. Hui D, Hladunewich MA. Chronic kidney disease and pregnancy. Obstet Gynecol. 2019;133(6):1182-94.
35. Gouveia IF, Silva JR, Santos C, Carvalho C. Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease. J Bras Nephrol. 2021;43:88-102. https://doi.org/10.1590/2175-8239-JBN-2020-0055
36. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91(5):1047-56.
37. Jungers P, Chauveau D. Pregnancy in renal disease. Kidney Int. 1997;52(4):871-85.
38. Huamán M, Quiroga de Michelena MI, St Martin B, Huamán M. Diagnóstico prenatal de anomalías cromosómicas. Rev Per Ginecol Obstet. 2016;62(3):269-77.
39. Zhang JJ, Ma XX, Hao L, Liu LJ, Lv JC, Zhang H. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10(11):1964-78.
40. World Health Organization. Guideline: vitamin D supplementation in pregnant women. Ginebra; 2012.
41. Chappell L C, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, Shennan AH. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128(19):2121-31.
42. Bramham K, Seed PT, Lightstone L, Nelson-Piercy C, Gill C, Webster P, Chappell LC. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89(4):874-85.
43. Piccoli GB, Gaglioti P, Attini R, Parisi S, Bossotti C, Olearo E, Todros T. Pre-eclampsia or chronic kidney disease? The flow hypothesis. Nephrol Dial Transplant. 2013;28(5):1199-1206.
44. Chapter 1: Diagnosis and evaluation of anemia in CKD. Kidney Int Suppl 2012 Aug;2(4):288-291. https://doi.org/10.1038/kisup.2012.33
2. Smyth A, Radovic M, Garovic VD. Women, kidney disease, and pregnancy. Adv Chronic Kidney Dis. 2013 Sep;20(5):402-10. https://doi.org/10.1053/j.ackd.2013.06.004
3. Choi C-Y, Cho N-J, Park S, Gil HW, Kim Y-S, Lee EY. A case report of successful pregnancy and delivery after peritoneal dialysis in a patient misdiagnosed with primary infertility. Medicine (Baltimore). 2018 Jun;97(26):e11148.
4. Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007 Jun;49(6):753-62. https://doi.org/10.1053/j.ajkd.2007.03.022
5. Jungers P, Chauveau D, Choukroun G, Moynot A, Skhiri H, Houillier P, Forget D, Grünfeld JP. Pregnancy in women with impaired renal function. Clin Nephrol. 1997 May;47(5):281-8.
6. Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996;335(10):226-32.
7. Davison J, Baylis C. Renal disease. En: De Swiet M, editor. Medical disorders in obstetric practice. 3.ª ed. Oxford: Blackwell Science; 1995. p. 226-305.
8. Guillén AO. Enfermedad renal crónica y embarazo. Acta Médica Grupo Angeles. 2018;16(S1):41-46.
9. Pérez Calvo C, Rico Fontalvo J, Lavalle López O, Daza Arnedo R, Pájaro Galvis N, Monterrosa Robles M, Vengoechea Visbal M. Enfermedad renal crónica en mujeres embarazadas. Rev Colomb Nefrol. 2021;8(1).
10. Pérez-Oliva Díaz J, Cantero Hernández R, Díaz Mayo J, Oviedo Rodríguez RA, Tamayo Pérez R. Diagnóstico, evaluación y manejo de la enfermedad renal en el embarazo: diagnóstico, evaluación y manejo de enfermedades renales durante el embarazo. Rev Haban Cienc Méd. 2016;15(5):834-58.
11. Gorostidi M, Santamaría R, Alcázar R, Fernández-Fresnedo G, Galcerán JM, Goicoechea M, Ruilope LM. Documento de la Sociedad Española de Nefrología sobre las guías KDIGO para la evaluación y el tratamiento de la enfermedad renal crónica. Nefrología (Madrid). 2014;34(3):302-16.
12. Bikbov B, Purcell C A, Levey A S, Smith M, Abdoli A, Abebe M, Owolabi MO. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-33.
13. Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA, Lasserson DS, Hobbs FR. Global prevalence of chronic kidney disease-a systematic review and meta-analysis. PloS One. 2016;11(7):e0158765. https://doi.org/10.1371/journal.pone.0158765
14. Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A, World Kidney Day Steering Committee. What we do and do not know about women and kidney diseases: questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman’s Day. Physiol Int. 2018;105(1):1-18.
15. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chronic Kidney Dis. 2007;14(2):132-45.
16. Fitzpatrick A, Mohammadi F, Jesudason S. Managing pregnancy in chronic kidney disease: improving outcomes for mother and baby. Int J Womens Health. 2016:273-85. https://doi.org/10.2147/IJWH.S76819
17. Carrillo-Mora P, García-Franco A, Soto-Lara M, Rodríguez-Vásquez G, Pérez-Villalobos J, Martínez-Torres D. Physiological changes during a normal pregnancy. Rev Fac Med UNAM. 2021;64(1):39-48.
18. Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013;20(3):209-14.
19. Williams D, Davison J. Chronic kidney disease in pregnancy. Br Med J. 2008;336(7637):211-15. https://doi.org/10.1136/bmj.39406.652986.BE
20. Wiles K S, Nelson-Piercy C, Bramham K. Reproductive health and pregnancy in women with chronic kidney disease. Nat Rev Nephrol. 2018;14(3):165-84.
21. González AO. Embarazo y riñón. Galicia: Servicio de Nefrología, CH Universitario de Ourense; 2020.
22. Bernasconi AR. Riñón y embarazo. II: glomerulopatías y embarazo. Rev Electron Biomed [internet]. 2016;(3):27-32. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=8883947
23. Aguirre Ospina OD, Buitrago CA. Enfermedad renal en la paciente obstétrica. En: Nefrología básica 2 [internet]. Asociación Colombiana de Nefrología; s. f. 357-70. Disponible en: https://asocolnef.com/libro-de-nefrologia-basica-2/
24. Hladunewich MA, Melamed N, Bramham K. Pregnancy across the spectrum of chronic kidney disease. Kidney Int. 2016 May;89(5):995-1007. https://doi.org/10.1016/j.kint.2015.12.050
25. Polanco NA, Gutiérrez KA, Morales NC. El embarazo en una paciente con enfermedad renal crónica en hemodiálisis: a propósito de un caso y revisión de la literatura. Diál Trasplant. 2015;36(1):34-9.
26. Piccoli GB, Cabiddu G, Attini R, Vigotti F N, Maxia S, Lepori N, Todros T. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol. 2015;26(8):2011-22.
27. Chinnappa V, Ankichetty S, Angle P, Halpern S. H. Chronic kidney disease in pregnancy. Int J Obst Anesth. 2013;22(3):223-30.
28. Kendrick J, Sharma S, Holmen J, Palit S, Nuccio E, Chonchol M. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015;66(1):55-9.
29. Merino JL, Espejo B, Ferreiro P, Bueno B, Paraíso V. Gestación en enfermedad renal crónica avanzada. Nefrología (Madrid). 2010;30(3):376-8.
30. Rojas-Rodríguez FO, Pérez-López MJ, Paniagua-Sierra R, Vázquez-Vega B, Chinolla-Arellano ZL, Zárate-González J, Juan-Carlos HR. Desenlaces clínicos en mujeres embarazadas en estadio I de la clasificación KDIGO comparado con mujeres sin enfermedad renal. Gac Méd Bilbao. 2020;117(1):28-34.
31. Manterola-Álvarez D, Hernández-Pacheco JA, Estrada-Altamirano A. Enfermedad renal crónica durante el embarazo: curso clínico y resultados perinatales en el Instituto Nacional de Perinatología Isidro Espinosa de los Reyes. Perinatol Reprod Hum. 2012;26(4):147-53.
32. Rojas WG, Cantillo JDJ, Cantillo MJ. Chronic renal disease and pregnancy: a challenge in clinical care and obstetric outcome. Acta Med Colomb. 2015;40(4):318-25.
33. Montaña A, Patiño N, Larrate C, Zambrano F A, Martínez J, Lozano H, Lozano E. Actualización en enfermedad renal poliquística. Rev Fac Med. 2018;66(1):107-16.
34. Hui D, Hladunewich MA. Chronic kidney disease and pregnancy. Obstet Gynecol. 2019;133(6):1182-94.
35. Gouveia IF, Silva JR, Santos C, Carvalho C. Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease. J Bras Nephrol. 2021;43:88-102. https://doi.org/10.1590/2175-8239-JBN-2020-0055
36. Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91(5):1047-56.
37. Jungers P, Chauveau D. Pregnancy in renal disease. Kidney Int. 1997;52(4):871-85.
38. Huamán M, Quiroga de Michelena MI, St Martin B, Huamán M. Diagnóstico prenatal de anomalías cromosómicas. Rev Per Ginecol Obstet. 2016;62(3):269-77.
39. Zhang JJ, Ma XX, Hao L, Liu LJ, Lv JC, Zhang H. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015;10(11):1964-78.
40. World Health Organization. Guideline: vitamin D supplementation in pregnant women. Ginebra; 2012.
41. Chappell L C, Duckworth S, Seed PT, Griffin M, Myers J, Mackillop L, Shennan AH. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128(19):2121-31.
42. Bramham K, Seed PT, Lightstone L, Nelson-Piercy C, Gill C, Webster P, Chappell LC. Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease. Kidney Int. 2016;89(4):874-85.
43. Piccoli GB, Gaglioti P, Attini R, Parisi S, Bossotti C, Olearo E, Todros T. Pre-eclampsia or chronic kidney disease? The flow hypothesis. Nephrol Dial Transplant. 2013;28(5):1199-1206.
44. Chapter 1: Diagnosis and evaluation of anemia in CKD. Kidney Int Suppl 2012 Aug;2(4):288-291. https://doi.org/10.1038/kisup.2012.33
How to Cite
Espitia Orejarena, D. M., Montero Acuña, M. C., Nasner Posso , Érika T., & Suárez Gómez, M. C. (2023). Chronic Kidney Disease and Pregnancy: A Review of the Literature. Universitas Medica, 64(3). https://doi.org/10.11144/Javeriana.umed64-3.erce
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