Division of Nephrology, Division of Obstetric Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Semin Nephrol. 2017 Jul;37(4):337-346. doi: 10.1016/j.semnephrol.2017.05.005.
Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of their kidney disease, and adverse pregnancy complications such as preeclampsia and preterm delivery. Earlier-stage CKD, as a rule, is a safer time to have a pregnancy, but even women with end-stage kidney disease have attempted pregnancy in recent years. As such, nephrologists need to be comfortable with pregnancy preparation and management at all stages of CKD. In this article, we review the renal physiologic response to pregnancy and the literature with respect to both expected maternal and fetal outcomes among young women at various stages of CKD, including those who attempt to conceive while on dialysis. The general management of young women with CKD and associated complications, including hypertension and proteinuria are discussed. Finally, the emotional impact these pregnancies may have on young women with a chronic disease and the potential benefits of care in a multidisciplinary environment are highlighted.
患有慢性肾脏病（CKD）的女性面临不良的妊娠相关结局风险，包括其潜在肾功能障碍的进展、肾脏疾病的发作以及子痫前期和早产等不良妊娠并发症。通常情况下，CKD 的早期阶段是妊娠较为安全的时期，但近年来甚至终末期肾病女性也尝试过妊娠。因此，肾病学家需要在 CKD 的各个阶段都能熟练地进行妊娠准备和管理。在本文中，我们回顾了妊娠对肾脏的生理反应，以及有关不同 CKD 阶段年轻女性的预期母婴结局的文献，包括那些正在接受透析治疗时试图怀孕的女性。讨论了年轻 CKD 女性的一般管理以及相关并发症，包括高血压和蛋白尿。最后，强调了这些妊娠可能对患有慢性疾病的年轻女性产生的情绪影响，以及多学科环境中护理的潜在益处。
