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J Clin Med. 2018 Nov 5;7(11). pii: E415. doi: 10.3390/jcm7110415.

Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases.

Author information

1
Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy. gbpiccoli@yahoo.it.
2
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. gbpiccoli@yahoo.it.
3
Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia. helena.zakharova@gmail.com.
4
Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia. helena.zakharova@gmail.com.
5
Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia. helena.zakharova@gmail.com.
6
Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy. rossella.attini@gmail.com.
7
Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico. maribaher@yahoo.es.
8
Instituto Nacional de Perinatologia, Mexico D.F. 01020, Mexico. ale_gaba@hotmail.com.
9
Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE. mona_539@yahoo.co.uk.
10
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--liu@hotmail.com.
11
Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon. maglo09@hotmail.com.
12
Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France. biancacovella@gmail.com.
13
Nefrologia Ospedale Brotzu, 09100 Cagliari, Italy. gianfranca.cabiddu@tin.it.
14
Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong. philipli@cuhk.edu.hk.
15
Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico. ggarcia1952@gmail.com.
16
Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada. alevin@providencehealth.bc.ca.

Abstract

Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

KEYWORDS:

chronic kidney disease (CKD), dialysis; kidney transplantation; pregnancy; pregnancy complications

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