Struttura Semplice of Nephrology, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.
BJOG. 2013 Mar;120(4):412-27. doi: 10.1111/1471-0528.12111. Epub 2013 Jan 15.
Kidney diseases, which have a prevalence of 3% in women of childbearing age, are increasingly encountered in pregnancy. Glomerulonephritis may develop or flare up in pregnancy, and a differential diagnosis with pre-eclampsia may be impossible on clinical grounds. Use of kidney biopsy is controversial, but a systematic review has not been carried out to date.
To review the literature on kidney biopsy in pregnancy, with a focus on indications, risks and timing.
Medline, Embase, CHINAL and the Cochrane Library were searched in September 2012, with 'pregnancy' and 'kidney biopsy' used as MESH and free terms, for the period 1980-2012. Results were filtered for 'human' if this option was available.
Biopsies during pregnancy and within 2 months after delivery. Case reports (fewer than five cases) and kidney grafts were excluded. Paper selection was performed in duplicate.
Data were extracted in duplicate. The high heterogeneity in study design necessitated that the review be narrative, except for data on adverse events, which were analysed with regard to the timing of kidney biopsy.
Of 949 references, 39 were selected, providing data on 243 biopsies in pregnancy and 1236 after delivery (timing was unclear in 106 women). The main aims of the studies were to define morphology in pre-eclampsia (23 studies), to carry out a risk-benefit analysis of kidney biopsy (11 studies), and to investigate pregnancy-related acute kidney injury (five studies). Four cases of major bleeding complications occurred at 23-26 weeks of gestation. Relevant complications were observed in 7% of women during pregnancy and 1% after delivery (P = 0.001). Kidney biopsy performed for the diagnosis of glomerulonephritis or pre-eclampsia led to therapeutic changes in 66% of cases.
AUTHORS' CONCLUSIONS: The evidence on kidney biopsy in pregnancy is heterogeneous, but a significantly higher risk of complications (relative to postpartum biopsy) was found, with a possible peak at around 25 gestational weeks.
在育龄妇女中，肾脏疾病的患病率为 3%，在妊娠期间越来越常见。在妊娠期间可能会发生或加重肾小球肾炎，并且在临床上可能无法与先兆子痫进行鉴别诊断。虽然肾活检的应用存在争议，但迄今为止尚未进行系统评价。
对妊娠期间肾活检的文献进行综述，重点关注适应证、风险和时机。
2012 年 9 月检索了 Medline、Embase、中国生物医学文献数据库（CBM）和 Cochrane 图书馆，使用“pregnancy”和“kidney biopsy”作为 MeSH 和自由词，检索年限为 1980 年至 2012 年。如果可用，将结果按“human”进行筛选。
在妊娠期间和分娩后 2 个月内进行的活检。排除病例报告（少于 5 例）和肾移植。采用双份法进行论文选择。
数据采用双份法提取。由于研究设计的高度异质性，除了与肾活检时机相关的不良事件数据外，本综述为叙述性综述。
在 949 篇参考文献中，有 39 篇入选，其中 243 例在妊娠期间进行，1236 例在分娩后进行（106 例的时机不明确）。研究的主要目的是在先兆子痫中确定形态学（23 项研究）、对肾活检的风险效益进行分析（11 项研究）以及调查妊娠相关的急性肾损伤（5 项研究）。4 例严重出血并发症发生在妊娠 23-26 周时。妊娠期间发生相关并发症的妇女占 7%，分娩后为 1%（P=0.001）。为诊断肾小球肾炎或先兆子痫而行肾活检，66%的病例导致治疗改变。
妊娠期间肾活检的证据存在异质性，但并发症风险（相对于产后活检）明显增加，可能在 25 孕周左右达到高峰。
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