Piccoli Giorgina Barbara, Cabiddu Gianfranca, Attini Rossella, Vigotti Federica, Fassio Federica, Rolfo Alessandro, Giuffrida Domenica, Pani Antonello, Gaglioti Piero, Todros Tullia
SS Nefrologia, Department of Clinical and Biological Sciences, ASOU San Luigi Gonzaga, University of Torino, Turin, Italy.
SCDU Nephrology, Brotzu Hospital, Cagliari, Italy.
Best Pract Res Clin Obstet Gynaecol. 2015 Jul;29(5):625-42. doi: 10.1016/j.bpobgyn.2015.02.005. Epub 2015 Mar 4.
Chronic kidney disease (CKD) is increasingly encountered in pregnancy because of greater diagnostic awareness, which is a reflection of the newer, broader definitions (i.e., any changes in blood or urine composition or at imaging, or a glomerular filtration rate (GFR) of <60 mL/min lasting at least 3 months) and of increased incidence (higher maternal age and better outcomes of several kidney diseases). CKD is extremely heterogeneous and may be described by the degree of GFR reduction (CKD stages), the presence of proteinuria and hypertension and the type of kidney disease; the risk of adverse pregnancy-related events increases as GFR decreases and it is affected by proteinuria and hypertension. Specific risks are reported in various diseases such as lupus nephropathy or diabetic nephropathy. While transplantation at least partially restores fertility in end-stage kidney disease, pregnancy on dialysis is increasingly reported. This chapter deals with the available evidence on the management of CKD patients in pregnancy.
由于诊断意识的提高，妊娠期间慢性肾脏病（CKD）越来越常见，这反映了更新、更广泛的定义（即血液或尿液成分或影像学检查的任何变化，或肾小球滤过率（GFR）<60 mL/min持续至少3个月）以及发病率的增加（产妇年龄增加和几种肾脏疾病的更好转归）。CKD极其异质性，可根据GFR降低程度（CKD分期）、蛋白尿和高血压的存在情况以及肾脏疾病类型来描述；与妊娠相关的不良事件风险随着GFR降低而增加，并且受蛋白尿和高血压影响。在各种疾病如狼疮性肾炎或糖尿病肾病中报告了特定风险。虽然移植至少部分恢复了终末期肾病患者的生育能力，但透析期间妊娠的报道越来越多。本章讨论了关于妊娠期间CKD患者管理的现有证据。
