Orozco-Guillien Alejandra Oralia, Muñoz-Manrique Cinthya, Reyes-López Maria Angelica, Perichat-Perera Otilia, Miranda-Araujo Osvaldo, D'Alessandro Claudia, Piccoli Giorgina B
Nephrology Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.
Nutrition and Bioprogramming Research Department, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, Mexico.
Kidney Blood Press Res. 2021;46(1):1-10. doi: 10.1159/000511539. Epub 2021 Feb 3.
How to manage patients with severe kidney disease in pregnancy is still a matter of discussion, and deciding if and when to start dialysis is based on the specialist's experience and dialysis availability. The effect of toxic substances usually cleared by the kidney may be more severe and readily evident. The review, and related case, underlines the importance of considering the presence of additives in food in delicate conditions, such as CKD pregnancy. The Case: A 39-year-old indigenous woman from a low-resourced area in Mexico was referred to the obstetric nephrology at 25 gestational weeks because of serum creatinine at 3.6 mg/dL, hypertension on low-dose alpha-methyl-dopa, and nephrotic-range proteinuria. Kidney ultrasounds showed small poorly differentiated kidneys; foetal ultrasounds detected a female foetus, normal for gestational age. The patient's baseline protein intake, which was estimated at 1.2-1.3 g/kg/day, was mostly of animal-origin (>70%) poor-quality food ("junk food"). In the proposed diet, protein intake was only slightly reduced (1.0-1.2 g/kg/day), but the source of proteins was changed (only 30% of animal origin) with attention to food quality. A remarkable decrease in BUN was observed, in concomitance with adequate dietary follow-up, with rapid rise of BUN when the patient switched temporarily back to previous habits. A healthy female baby weighing 2,460 g (11th centile for gestational age) was delivered at 37 gestational weeks. Discussion and Literature Review: While data on patients with chronic kidney disease are scant, the long list of contaminants present in food, especially if of low quality, should lead us to reflect on their potential negative effect on kidney function and make us realize that eating healthy, unprocessed "organic" food should be encouraged, in delicate conditions such as pregnancy and breastfeeding and for young children, in particular when kidney function is failing. The case herein described gave us the opportunity to reflect on the importance of diet quality and on the potential risks linked to food additives, many of which, including phosphates and potassium, are not declared on food labels, while others, including dyes, antioxidants, thickeners, emulsifiers, and preservatives, are qualitatively, but not quantitatively, reported.
如何管理妊娠合并严重肾病的患者仍是一个有待探讨的问题，而决定是否以及何时开始透析取决于专家的经验和透析的可及性。通常由肾脏清除的有毒物质的影响可能更为严重且易于显现。该综述及相关病例强调了在诸如慢性肾脏病合并妊娠等特殊情况下考虑食物中添加剂存在的重要性。病例：一名来自墨西哥资源匮乏地区的39岁原住民女性，在孕25周时因血清肌酐为3.6mg/dL、服用小剂量α-甲基多巴控制高血压以及肾病范围蛋白尿而被转诊至产科肾脏病科。肾脏超声显示肾脏体积小且分化不良；胎儿超声检查发现是一名女胎，孕周正常。该患者的基线蛋白质摄入量估计为1.2 - 1.3g/kg/天，主要来源于动物（>70%），是质量较差的食物（“垃圾食品”）。在拟定的饮食方案中，蛋白质摄入量仅略有减少（1.0 - 1.2g/kg/天），但蛋白质来源发生了变化（仅30%来自动物），同时注重食物质量。在进行充分的饮食随访过程中，观察到血尿素氮显著下降，而当患者暂时恢复以前的饮食习惯时，血尿素氮迅速上升。孕37周时分娩出一名健康女婴，体重2460g（孕周第11百分位）。讨论与文献综述：虽然关于慢性肾脏病患者的数据较少，但食物中存在的一长串污染物，尤其是质量较差的食物中的污染物，应促使我们思考它们对肾功能的潜在负面影响，并使我们认识到在妊娠、哺乳等特殊情况下以及对于幼儿，特别是当肾功能衰竭时，应鼓励食用健康、未加工的“有机”食品。本文所述病例让我们有机会思考饮食质量的重要性以及与食品添加剂相关的潜在风险，其中许多添加剂，包括磷酸盐和钾，在食品标签上未标明，而其他一些添加剂，包括染料、抗氧化剂、增稠剂、乳化剂和防腐剂，虽有定性但无定量报告。
