Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, United Kingdom.
Division of Nephrology, Department of Medicine, University of California, San Diego, California, USA.
Kidney Int. 2017 May;91(5):1047-1056. doi: 10.1016/j.kint.2016.10.045. Epub 2017 Feb 13.
Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks. These pregnancies should be deemed high risk and they require close antenatal monitoring from an expert multidisciplinary team. We discuss the effect of pregnancy on CKD, and also current guidelines and literature with specific reference to transplantation, autoimmune disease, and medication use in pregnancy. We also discuss the benefits of prepregnancy counseling and give practical recommendations to advise pregnant women with renal disease.
慢性肾脏病（CKD）影响高达 6%的高收入国家育龄妇女，据估计，有 3%的孕妇受其影响。晚期肾功能不全、蛋白尿、高血压和基础原发性肾病控制不佳，都是对母婴和肾脏预后不良的重大风险因素。为了获得最佳的母婴结局，因此至关重要的是，尽可能地计划这些妊娠，以便有机会提前对妇女及其伴侣进行咨询，并优化这些风险。这些妊娠应被视为高危妊娠，需要来自专家多学科团队的密切产前监测。我们讨论了妊娠对 CKD 的影响，以及当前的指南和文献，特别是关于移植、自身免疫性疾病和妊娠期间药物使用的内容。我们还讨论了孕前咨询的益处，并提出了实用建议，为患有肾脏疾病的孕妇提供指导。
