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. 2021 Jan-Mar;43(1):88-102.
doi: 10.1590/2175-8239-JBN-2020-0055.

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

[Article in English, Portuguese]
Inês Filipe Gouveia  1 , Joana Raquel Silva  1 , Clara Santos  2 , Claudina Carvalho  1
Affiliations

Maternal and fetal outcomes of pregnancy in chronic kidney disease: diagnostic challenges, surveillance and treatment throughout the spectrum of kidney disease

[Article in English, Portuguese]
Inês Filipe Gouveia et al. J Bras Nefrol. 2021 Jan-Mar.

Abstract
in English, Portuguese

Pregnancy requires several physiological adaptations from the maternal organism, including modifications in the glomerular filtration rate and renal excretion of several products. Chronic kidney disease (CKD) can negatively affect these modifications and consequently is associated with several adverse maternal and fetal adverse outcomes (gestational hypertension, progression of renal disease, pre-eclampsia, fetal growth restriction, and preterm delivery). A multidisciplinary vigilance of these pregnancies is essential in order to avoid and/or control the harmful effects associated with this pathology. Dialysis and transplantation can decrease the risks of maternal and fetal complications, nonetheless, the rates of complications remain high comparing with a normal pregnancy. Several recent developments in this area have improved quality and efficacy of treatment of pregnant women with CKD. This article summarizes the most recent literature about CKD and pregnancy.

A gravidez requer várias adaptações fisiológicas do organismo materno, incluindo modificações na taxa de filtração glomerular e na excreção renal de vários produtos. A doença renal crônica (DRC) pode afetar negativamente essas modificações e, consequentemente, está associada a vários desfechos adversos maternos e fetais (hipertensão gestacional, progressão da doença renal, pré-eclâmpsia, restrição do crescimento fetal e parto prematuro). A vigilância multidisciplinar dessas gestações é fundamental para evitar e/ou controlar os efeitos deletérios associados a essa patologia. A diálise e o transplante podem diminuir os riscos de complicações maternas e fetais, no entanto, as taxas de complicações permanecem altas em comparação com uma gravidez normal. Vários desenvolvimentos recentes nesta área melhoraram a qualidade e a eficácia do tratamento de mulheres grávidas com DRC. Este artigo resume a literatura mais recente sobre DRC e gravidez.

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Conflict of interest statement

Conflict of Interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Recommendations of the American Society of Transplantations to be followed before conception.
Figure 2
Figure 2. Chronic kidney disease in pregnancy - suggested management based on the Italian group approach ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; SLE Systemic lupus erythematosus.
See this image and copyright information in PMC

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