Kendrick Jessica, Holmen John, You Zhiying, Smits Gerard, Chonchol Michel
Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO; Denver Health Medical Center, Denver, CO.
Intermountain Healthcare, Salt Lake City, UT.
Am J Kidney Dis. 2017 Oct;70(4):506-511. doi: 10.1053/j.ajkd.2017.02.367. Epub 2017 Apr 7.
Data regarding the effect of a solitary kidney during pregnancy have come from studies of living kidney donors. We evaluated the risk for adverse pregnancy outcomes in women with a single kidney from renal agenesis.
Matched cohort study.
SETTING & PARTICIPANTS: Using data from 7,079 childbirths from an integrated health care delivery system from 1996 through 2015, we identified births from women with renal agenesis. Only first pregnancies and singleton births were included. After excluding those with diabetes and kidney disease, 200 women with renal agenesis were matched 1:4 by age (within 2 years), race, and history of hypertension to women with 2 kidneys.
Renal agenesis defined by International Classification of Diseases, Ninth Revision (ICD-9) codes prior to pregnancy.
The primary outcome was adverse maternal outcomes, including preterm delivery, delivery by cesarean section, preeclampsia/eclampsia, and hospital length of stay. Adverse neonatal end points were considered as a secondary outcome and included low birth weight (<2,500g) and infant death/transfer to acute inpatient facility.
Mean gestational age at delivery was 37.9±2.1 weeks for women with renal agenesis compared to 38.6±1.8 weeks for women with 2 kidneys. Compared with women with 2 kidneys, those with renal agenesis had increased risk for preterm delivery (OR, 2.88; 95% CI, 1.86-4.45), delivery by cesarean section (OR, 2.11; 95% CI, 1.49-2.99), preeclampsia/eclampsia (OR, 2.41; 95% CI, 1.23-4.72), and length of stay longer than 3 days (OR, 1.81; 95% CI, 1.18-2.78). Renal agenesis was not significantly associated with increased risk for infant death/transfer to acute facility (OR, 2.60; 95% CI, 0.57-11.89) or low birth weight after accounting for preterm delivery (OR, 2.11; 95% CI, 0.76-5.88).
Renal agenesis was identified by ICD-9 code, not by imaging of the abdomen.
Women with unilateral renal agenesis have a higher risk for adverse outcomes in pregnancy.
关于孕期单肾影响的数据来自活体肾供体研究。我们评估了肾发育不全所致单肾女性不良妊娠结局的风险。
配对队列研究。
利用1996年至2015年综合医疗保健系统中7079例分娩的数据，我们确定了肾发育不全女性的分娩情况。仅纳入首次妊娠和单胎分娩。在排除患有糖尿病和肾病的女性后，将200例肾发育不全女性按年龄（2年内）、种族和高血压病史以1:4的比例与有两个肾脏的女性进行配对。
根据国际疾病分类第九版（ICD - 9）编码在妊娠前确定肾发育不全。
主要结局是不良母体结局，包括早产、剖宫产、先兆子痫/子痫以及住院时间。不良新生儿终点被视为次要结局，包括低出生体重（<2500g）和婴儿死亡/转至急性住院机构。
肾发育不全女性的平均分娩孕周为37.9±2.1周，有两个肾脏的女性为38.6±1.8周。与有两个肾脏的女性相比，肾发育不全女性早产风险增加（OR，2.88；95%CI，1.86 - 4.45）、剖宫产风险增加（OR，2.11；95%CI，1.49 - 2.99）、先兆子痫/子痫风险增加（OR，2.41；95%CI，1.23 - 4.72）以及住院时间超过3天的风险增加（OR，1.81；95%CI，1.18 - 2.78）。在考虑早产因素后，肾发育不全与婴儿死亡/转至急性机构风险增加（OR，2.60；95%CI，0.57 - 11.89）或低出生体重无显著关联（OR，2.11；95%CI，0.76 - 5.88）。
肾发育不全是通过ICD - 9编码确定的，而非腹部影像学检查。
单侧肾发育不全女性孕期不良结局风险较高。
