Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya7595010.26442/00403660.2021.06.200867Research ArticleAnalysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney diseaseDemyanovaKseniia A.ksedem@gmail.comhttps://orcid.org/0000-0001-8927-5841KozlovskayaNatalia L.ksedem@gmail.comhttps://orcid.org/0000-0002-4275-0315KorotchaevaYuliia V.ksedem@gmail.comhttps://orcid.org/0000-0002-0880-6346ApresyanSergei V.ksedem@gmail.comhttps://orcid.org/0000-0002-7310-974XRylcevaLidiia P.ksedem@gmail.comhttps://orcid.org/0000-0001-6153-360XUsatenkoGalina V.ksedem@gmail.comhttps://orcid.org/0000-0003-4057-0190LugovojArtem O.ksedem@gmail.comhttps://orcid.org/0000-0002-3344-7891VorobyevaMariia A.ksedem@gmail.comhttps://orcid.org/0000-0002-6932-2054BondarenkoTatiana V.ksedem@gmail.comhttps://orcid.org/0000-0003-0701-1805BespalovaAnna V.ksedem@gmail.comhttps://orcid.org/0000-0002-6993-6291VolkovaOlga A.ksedem@gmail.comhttps://orcid.org/0000-0002-1996-2133People’s Friendship University of RussiaEramishantsev City Clinical HospitalSechenov First Moscow State Medical University (Sechenov University)150620219366856921007202110072021Copyright © 2021, Consilium Medicum2021<p><strong>Background</strong>. Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited.</p>
<p><strong>Aim</strong>. To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a4.</p>
<p><strong>Materials and methods</strong>. Thirty five pregnant women with CKD stages 34 were included: 3a 12 (34.3%) patients, stage 3b 10 (28.6%), stage 4 13 (37.1%).</p>
<p><strong>Results</strong>. Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted.</p>
<p><strong>Conclusion</strong>. A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.</p>pregnancychronic kidney diseasechronic kidney failureбеременностьхроническая болезнь почекхроническая почечная недостаточность[Тареева И.Е., Рогов В.А. Нефрит и беременность. Новый мед. журн. 1996;1:14. [Tareeva IE, Rogov VA. Jade and pregnancy. New medical journal.1996;1:14 (in Russian)].][Рогов В.А., Шилов Е.М., Козловская Н.Л., и др. Хронический гломерулонефрит и беременность. Терапевтический архив. 2004;76(9):71-6 [Rogov VA, Shilov EM, Kozlovskaya NL, et al. Chronic glomerulonephritis and pregnancy. Terapevticheskii Arkhiv (Ter. Arkh.). 2004;76(9):71-6 (in Russian)].][Imbasciati E, Gregorini G, Cabiddu G, et al. Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis. 2007;49:753-62. DOI:10.1053/j.ajkd.2007.03.022][Maynard SE, Thadhani R. Pregnancy and the Kidney. J Am Soc Nephrol. 2009;20(1):14-22. DOI:10.1681/ASN.2008050493][Piccoli GB, Conijn A, Attini R, et al. Pregnancy in chronic kidney disease: need for a common language. J Nephrol. 2011;24(3):282-99. DOI:10.5301/JN.2011.7978][Bar J, Ben-Rafael Z, Padoa A, et al. Prediction of pregnancy outcome in subgroups of women with renal disease. Clin Nephrol. 2000;53(6):437-44. DOI: 10.1097/00006254-200103000-00004][Piccoli GB, Cabiddu G, Attini R, et al. Risk of Adverse Pregnancy Outcomes in Women with CKD. J Am Soc Nephrol. 2015;26:2011-22. DOI:10.1681/ASN.2014050459][Webster P, Lightstone L, McKay DB, Josephson MA. Pregnancy in chronic kidney disease and kidney transplantation. Kidney Int. 2017;91:1047-56. DOI:10.1016/j.kint.2016.10.045; PMID: 28209334.][Strevens H, Wide-Swensson D, Hansen A, et al. Glomerular endotheliosis in normal pregnancy and pre-eclampsia. BJOG. 2003;110(9):831-6. DOI:10.1046/j.1471-0528.2003.00074.x][Wiles K, Bramham K, Seed PT, et al. Diagnostic indicators of superimposed preeclampsia in women with CKD. Kidney Int Rep. 2019;4:842-53. DOI:0.1016/j.ekir.2019.03.012][Никольская И.Г., Прокопенко Е.И., Новикова С.В., и др. Осложнения и исходы беременности при хронической почечной недостаточности. Альманах клинической медицины. 2015;(37):52-69 [Nikol'skaya IG, Prokopenko EI, Novikova SV, et al. Complications and outcomes of pregnancy in chronic kidney disease. Almanac of Clinical Medicine. 2015;(37):52-69 (in Russian)]. DOI:10.18786/2072-0505-2015-37-52-69][Park S, Lee SM, Park JS, et al. Midterm eGFR and Adverse Pregnancy Outcomes: The Clinical Significance of Gestational Hyperfiltration. Clin J Am Soc Nephrol. 2017;12(7):1048-56. DOI:10.2215/CJN.12101116][Williams D, Davison J. Chronic kidney disease in pregnancy. BMJ. 2008;336(7637):211-5. DOI:10.1136/bmj.39406.652986.BE][Blom K, Odutayo A, Bramham K, Hladunewich MA. Pregnancy and Glomerular Disease. A Systematic Review of the Literature with Management Guidelines. Clin J Am Soc Nephrol. 2017;12(11):1862-72. DOI:10.2215/CJN.00130117][Wiles K, Chappell L, Clark K, et al. Clinical practice guideline on pregnancy and renal disease. BMC Nephrology. 2019;20(1):401. DOI:10.1186/s12882-019-1560-2]