Hidaka M, Ohi H, Ohsawa I, Endo M, Fujita T, Kanmatsuse K
Second Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Nihon Jinzo Gakkai Shi. 1999 Jun;41(4):454-9.
When women with kidney disease wish to have children, concerns are raised about the adverse effect on their renal function. Although the situation is less clear in regard to the effects, there is general agreement that a moderately severe decrease in renal function, especially in the presence of significant hypertension, reduces the chance of conception, and a successful outcome of gestation. On the other hand, several reports maintain that in most patients, pregnancy does not change the natural history of glomerular disease. Accordingly, we reported successful cases in whom renal function remained preserved. The three cases suffered from different types of glomerulonephritis (GN) and percutaneous renal biopsies were conducted before pregnancy. All biopsy specimens were examined by light and immunofluorescence microscopy, and were diagnosed as IgA nephropathy, sclerosing GN and membranoproliferative GN, respectively. Since severe histological findings were found and their data worsened (serum creatinine > 1.3 mg/dl, 24-hr creatinine clearance < 70 ml/min), their chance of having children appeared low. However, as we did not observe deterioration of clinical findings and hypertension over the ten-year follow-up, we allowed conception resulting in the birth of normal children. Thus we should mention the relatively favourable courses of nephropathy in some patients with GN, particularly in patients with stable renal disease and normal blood pressure, it should not be considered an indication for termination. It is important to observe the status of glomerular disease for as long as possible.
当患有肾脏疾病的女性想要孩子时，人们会担心这对她们的肾功能产生不良影响。尽管关于其影响的情况尚不太明确，但人们普遍认为，肾功能中度严重下降，尤其是在存在显著高血压的情况下，会降低受孕几率和妊娠的成功几率。另一方面，一些报告认为，在大多数患者中，妊娠并不会改变肾小球疾病的自然病程。因此，我们报告了肾功能得以保留的成功案例。这三例患者患有不同类型的肾小球肾炎（GN），并在妊娠前进行了经皮肾活检。所有活检标本均通过光镜和免疫荧光显微镜检查，分别诊断为IgA肾病、硬化性GN和膜增生性GN。由于发现了严重的组织学表现且其数据恶化（血清肌酐>1.3mg/dl，24小时肌酐清除率<70ml/min），她们生育孩子的几率似乎很低。然而，由于我们在十年随访中未观察到临床症状和高血压的恶化，我们允许她们受孕并诞下了健康的孩子。因此，我们应该提到，一些GN患者的肾病病程相对较好，尤其是对于肾病稳定且血压正常的患者，不应将其视为终止妊娠的指征。尽可能长时间地观察肾小球疾病的状况非常重要。
