Biesenbach G, Grafinger P, Stöger H, Zazgornik J
2nd Department of Medicine, General Hospital, Linz, Austria.
J Nephrol. 1999 Jan-Feb;12(1):41-6.
Pregnancy in type 1 diabetic women with overt nephropathy can lead to a further deterioration in renal function but it is not clear at what level of pre-conceptional GFR the risk for worsening of renal function begins to increase. Therefore we investigated the influence of pregnancy on renal function in 12 women (14 pregnancies) with pre-conceptional macroproteinuria and near-normal creatinine clearance (range 37-93 ml/min/1.73m2). S-creatinine, creatinine clearance (CrCL), HbA1c and blood pressure (BP) were measured before conception, during each trimester (12th and 24th week of gestation and last week before delivery) and three and six months post-partum. In five diabetic women with six pregnancies (group A) there was a physiological increase in CrCl of 36% up until the 24th week of gestation; their pre-conceptional mean CrCl was 80 (range 70-93) ml/min/1.73m2. In seven women with eight pregnancies (group B) CrCl decreased by 16% during the first two trimesters; the mean CrCl before conception was 61 (37-73) ml/min/1.73m2. In the last week before delivery CrCl worsened transiently in three cases in group A and four in group B, due to pre-eclampsia. Three months post-partum the mean CrCl in group A was 78 (70-91) ml/min/1.73m2, approximately the same as before pregnancy. In group B the mean CrCl was 39 (22-68) ml/min/1.73m2 at this same time; this was 36% lower than the pre-conceptional clearance. Mean HbA1c in both groups were approximately the same, but mean BP tended to be higher during pregnancy in group B, especially in the week before delivery (p<0.05). We conclude that in a high percentage of nephropathic diabetic women with significantly low CrCl before conception, renal function worsens during and after pregnancy. Inadequate antihypertensive therapy may contribute to this.
1型糖尿病合并显性肾病的女性怀孕可能会导致肾功能进一步恶化，但尚不清楚孕前肾小球滤过率（GFR）处于何种水平时，肾功能恶化的风险开始增加。因此，我们研究了怀孕对12名（14次妊娠）孕前有大量蛋白尿且肌酐清除率接近正常（范围为37 - 93 ml/min/1.73m²）的女性肾功能的影响。在孕前、孕期各阶段（妊娠第12周和第24周以及分娩前最后一周）以及产后三个月和六个月测量血清肌酐、肌酐清除率（CrCL）、糖化血红蛋白（HbA1c）和血压（BP）。在5名患有6次妊娠的糖尿病女性（A组）中，直到妊娠第24周CrCL生理性增加了36%；她们孕前的平均CrCL为80（范围70 - 93）ml/min/1.73m²。在7名患有8次妊娠的女性（B组）中，CrCL在前两个孕期下降了16%；孕前的平均CrCL为61（37 - 73）ml/min/1.73m²。在分娩前最后一周，由于先兆子痫，A组有3例、B组有4例的CrCL短暂恶化。产后三个月，A组的平均CrCL为78（70 - 91）ml/min/1.73m²，与孕前大致相同。此时B组的平均CrCL为39（22 - 68）ml/min/1.73m²；比孕前清除率低36%。两组的平均HbA1c大致相同，但B组孕期平均血压往往更高，尤其是在分娩前一周（p<0.05）。我们得出结论，在很大比例的孕前CrCL显著降低的糖尿病肾病女性中，肾功能在孕期及产后会恶化。降压治疗不足可能是导致这一情况的原因。
