Feng Zichun, Minard Charles, Raghavan Rajeev
Department of Internal Medicine, Dan L. Duncan Institute for Clinical, Translational Research, and Division of Nephrology, Baylor College of Medicine, Houston, TX, USA.
Clin Nephrol. 2015 May;83(5):272-8. doi: 10.5414/cn108516.
Maternal and fetal outcomes of pregnant women with advanced chronic kidney disease (CKD stage 4 and 5) are not well chronicled. Since 1980, we could locate only five published case series'studying this population. This study examines nine pregnant women with severe CKD (defined as estimated GFR < 30 mL/min) and compares their materno-fetal outcomes with a cohort of women with an eGFR 45 - 100 mL/min and pre-pregnancy proteinuria (mild CKD). This is a retrospective, single-center study nd statistical analyses include Fisher' exact test, nonparametric Wilcoxon rank sum, and exact logistic regression. Compared to women with mild CKD, women with severe CKD have higher rates of pre-term delivery (89% vs. 41%, p = 0.02) and a higher average eGFR reduction during pregnancy (26.1% vs. 0%, p = 0.04). Both groups had similar rate of caesarean section, pre-eclampsia, and adverse fetal outcomes including perinatal death, oligohydramnios, and intrauterine growth retardation. Compared to published outcomes of pregnant women receiving hemodialysis, our cohort of women with severe CKD and not on dialysis had a higher incidence of pre-eclampsia and premature birth. In conclusion, the incidence of preterm delivery, small for gestational age, and decline of maternal renal function increased with a reduction in eGFR. Women with severe CKD (eGFR < 30 mL/min) may experience a reduced rate of pre-eclampsia and longer gestation with earlier initiation of dialysis.
晚期慢性肾脏病（慢性肾脏病4期和5期）孕妇的母婴结局尚无详尽记录。自1980年以来，我们仅找到五篇已发表的研究该人群的病例系列报道。本研究对9例重度慢性肾脏病孕妇（定义为估算肾小球滤过率<30 mL/min）进行了研究，并将其母婴结局与估算肾小球滤过率为45 - 100 mL/min且孕前有蛋白尿（轻度慢性肾脏病）的一组孕妇进行了比较。这是一项回顾性单中心研究，统计分析包括Fisher精确检验、非参数Wilcoxon秩和检验以及精确逻辑回归。与轻度慢性肾脏病孕妇相比，重度慢性肾脏病孕妇的早产率更高（89%对41%，p = 0.02），孕期平均估算肾小球滤过率降低幅度更大（26.1%对0%，p = 0.04）。两组的剖宫产率、子痫前期发生率以及包括围产期死亡、羊水过少和胎儿生长受限在内的不良胎儿结局发生率相似。与接受血液透析的孕妇的已发表结局相比，我们这组未接受透析的重度慢性肾脏病孕妇的子痫前期和早产发生率更高。总之，随着估算肾小球滤过率降低，早产、小于胎龄儿的发生率以及孕妇肾功能下降均增加。重度慢性肾脏病（估算肾小球滤过率<30 mL/min）孕妇可能子痫前期发生率降低，且透析起始较早时妊娠时间更长。
