Unità Materno-Fetale, Dipartimento di Chirurgia, Università di Torino, Turin, Italy.
Nephrologie, Centre Hospitalier Le Mans, 194 Avenue Roubillard, 72000, Le Mans, France.
J Nephrol. 2018 Dec;31(6):833-846. doi: 10.1007/s40620-018-0515-1. Epub 2018 Jul 31.
Reflux nephropathy is a common urinary tract malformation, and a substantial cause of morbidity in women of childbearing age. While recent studies provide further new information on pregnancy-related outcomes, their results are heterogeneous and a systematic meta-analysis may help the interpretation. The aim of this review was to analyze pregnancy-related outcomes in the recent literature on reflux nephropathy (2000-2016), to perfect the estimation of risks, and to identify specific research needs.
We searched Medline, EMBASE and the Cochrane review databases for the period 2000-2016 (PROSPERO registration no. 42016042713).
all case series and case reports dealing with reflux nephropathy and reporting on at least one pregnancy outcome. Data were extracted from eligible case series (≥ 6 cases). For the outcomes preeclampsia (PE), pregnancy-induced hypertension (PIH), preterm birth, and newborns small for gestational age, we employed as a control group the low-risk pregnancies from a multicenter database including 1418 live-born singletons. Case reports were analyzed narratively.
The search retrieved 2507 papers, of which 7 case series and 4 case reports were retained. The series report on 434 women with 879 pregnancies; no study reported controls. Compared to the low-risk controls, the meta-analysis showed an increased risk of PIH (odds ratio, OR 5.55; confidence interval, CI 3.56-8.66), PE (OR 6.04; CI 2.41-15.13), and all hypertensive disorders combined (OR 10.43; CI 6.90-15.75). No difference was observed in preterm delivery and caesarean sections. A higher incidence of stillbirth was reported in one paper. Conversely, the 4 case reports (on 10 pregnancies) alert us to a potentially severe complication, hydro(uretero)nephrosis with or without infection.
Reflux nephropathy is associated with an increased risk of PIH and PE, but not of preterm delivery, suggesting the occurrence of late 'maternal' PE. The finding of a higher incidence of stillbirths in one series requires further analysis. Strict follow-up of these women is needed, in particular in late pregnancy stages, to avoid and manage in particular hypertensive pregnancy complications.
反流性肾病是一种常见的尿路畸形，也是育龄妇女发病率较高的主要原因。虽然最近的研究提供了更多关于妊娠相关结果的新信息，但结果存在异质性，系统的荟萃分析可能有助于解释。本研究旨在分析 2000 年至 2016 年反流性肾病（Reflux nephropathy）相关文献中妊娠相关结局，完善风险评估，并确定具体的研究需求。
我们检索了 Medline、EMBASE 和 Cochrane 评价数据库，检索时间为 2000 年至 2016 年（PROSPERO 注册号：42016042713）。
所有涉及反流性肾病且至少报告 1 项妊娠结局的病例系列和病例报告。从合格的病例系列中提取数据（≥6 例）。对于子痫前期（PE）、妊娠高血压（PIH）、早产和新生儿小于胎龄，我们使用包含 1418 例活产单胎的多中心数据库中的低危妊娠作为对照组。病例报告进行了叙述性分析。
检索到 2507 篇论文，其中保留了 7 个病例系列和 4 个病例报告。该系列报告了 434 名女性和 879 例妊娠；没有研究报告对照组。与低危对照组相比，荟萃分析显示 PIH（比值比，OR 5.55；置信区间，CI 3.56-8.66）、PE（OR 6.04；CI 2.41-15.13）和所有高血压疾病合并（OR 10.43；CI 6.90-15.75）的风险增加。早产和剖宫产无差异。一篇论文报道了较高的死胎发生率。相反，4 个病例报告（共 10 例妊娠）提醒我们存在潜在的严重并发症，即伴有或不伴有感染的肾盂（输尿管）积水。
反流性肾病与 PIH 和 PE 风险增加相关，但与早产无关，提示发生晚期“母体”PE。一个系列中较高的死胎发生率需要进一步分析。需要对这些妇女进行严格的随访，特别是在妊娠晚期，以避免和管理特别是妊娠高血压并发症。
