Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Kidney Disease Network, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY.
Semin Nephrol. 2017 Jul;37(4):327-336. doi: 10.1016/j.semnephrol.2017.05.004.
Chronic kidney disease (CKD) affects hypothalamic-pituitary-gonadal axis function, leading to menstrual abnormalities, sexual dysfunction, functional menopause, and loss of fertility. Pregnancy in a patient with CKD is associated with a higher risk of complications to both the mother and the fetus, highlighting the importance of contraceptive counseling at all stages of CKD. There has been limited research on the safety and efficacy of different contraceptive methods in the CKD population, and it is important to tailor the choice of contraception to the patient's lifestyle and comorbidity status. Cyclophosphamide is a commonly used immunosuppressive agent that impairs fertility in a dose-dependent fashion, with greater impact in older women of child-bearing age. Strategies to reduce the impact of cyclophosphamide on ovarian reserve as well as fertility preservation technologies are options to consider when treating immune-mediated CKD. A multidisciplinary approach in counseling the woman with CKD who wishes to contemplate or avoid pregnancy is necessary to optimize outcomes. Further research in this important area is required.
慢性肾脏病（CKD）会影响下丘脑-垂体-性腺轴的功能，导致月经异常、性功能障碍、功能性绝经和生育能力丧失。患有 CKD 的患者怀孕会增加母婴双方并发症的风险，这凸显了在 CKD 的各个阶段进行避孕咨询的重要性。关于不同避孕方法在 CKD 人群中的安全性和有效性的研究有限，根据患者的生活方式和合并症状况来选择合适的避孕方法非常重要。环磷酰胺是一种常用的免疫抑制剂，会导致生育能力受损，且与年龄较大的育龄期女性的影响更大。在治疗免疫介导的 CKD 时，可以考虑采用降低环磷酰胺对卵巢储备影响的策略以及生育力保存技术。在为希望考虑或避免怀孕的 CKD 女性提供咨询时，需要采用多学科方法，以优化结果。在这个重要领域需要开展更多的研究。
