Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Jal, Mexico.
Instituto Nacional de Perinatología, México City, Mexico.
J Nephrol. 2017 Dec;30(6):773-780. doi: 10.1007/s40620-017-0444-4. Epub 2017 Oct 11.
The incidence of acute kidney injury in pregnancy (P-AKI) in developed countries is significantly lower than in developing ones, where it is estimated to range between 4 and 26%. Mortality in cases of P-AKI requiring dialysis is high, varying from 20 to 80%. In developing countries, clinical decisions are often based on the availability of services and not on needs. Prenatal surveillance in Mexico does not include serum creatinine, limiting the potential for early diagnosis of AKI and CKD and their differential diagnosis. There are few specialized centers for the care of a pregnancy complicated with kidney disease in Mexico. P-AKI superimposed on preexistent, and usually undiagnosed CKD, is common: in Guadalajara 10 out of the 27 patients with Stage 3-5 CKD or nephrotic proteinuria, that were followed in 2013-2015, required renal replacement therapy (RRT) in pregnancy; in the same period in Mexico City out of 18 patients with P-AKI requiring dialysis, 5 remained dialysis dependent, 3 started dialysis in the following year after their pregnancy and only 1 fully recovered renal function. The grim prognosis is exacerbated by the fact that 70% of Mexicans are not reimbursed for dialysis, and pregnancy-related coverage lasts for only 42 days after delivery. Perinatal results are no less troubling, as most patients with P-AKI give birth preterm to small or very small babies. While our data do not allow us to evaluate needs, they do make it possible to define the complexity of the problems faced in the care of P-AKI in Mexico. Early diagnosis of P-AKI and chronic kidney disease (CKD) is needed to protect mothers and children and the country urgently needs programs to enable it to fulfil the World Health Organization's imperative that we "make every mother and child count".
在发达国家，妊娠相关急性肾损伤（P-AKI）的发病率明显低于发展中国家，后者的发病率估计在 4%至 26%之间。需要透析治疗的 P-AKI 病例死亡率较高，从 20%到 80%不等。在发展中国家，临床决策往往基于服务的可及性，而不是基于需求。墨西哥的产前监测不包括血清肌酐，这限制了 AKI 和 CKD 的早期诊断及其鉴别诊断的可能性。墨西哥很少有专门的肾脏疾病妊娠护理中心。P-AKI 常合并预先存在且通常未被诊断的 CKD：在瓜达拉哈拉，2013 年至 2015 年间，27 名 3-5 期 CKD 或肾病性蛋白尿患者中，有 10 名需要在妊娠期间进行肾脏替代治疗（RRT）；在同一时期的墨西哥城，18 名需要透析的 P-AKI 患者中，有 5 名仍依赖透析，3 名在妊娠后次年开始透析，只有 1 名完全恢复了肾功能。由于 70%的墨西哥人没有透析报销，而且妊娠相关的报销仅在分娩后持续 42 天，这一严峻的预后情况更加恶化。围产期结果也同样令人担忧，因为大多数 P-AKI 患者早产，婴儿体重较轻或非常小。虽然我们的数据无法评估需求，但它们确实可以说明在墨西哥 P-AKI 护理中所面临问题的复杂性。需要早期诊断 P-AKI 和慢性肾脏病（CKD），以保护母亲和儿童，并且该国迫切需要制定计划，以使其能够履行世界卫生组织的要求，即“让每个母亲和儿童都算数”。
