Drapeau Leo, Beaumier Mathilde, Esbelin Julie, Comoz François, Figueres Lucile, Piccoli Giorgina Barbara, Kervella Delphine
Néphrologie et Immunologie Clinique, CHU de Nantes, Nantes Université, 44000 Nantes, France.
Néphrologie, Centre Hospitalier Public du Cotentin, 50100 Cherbourg, France.
J Clin Med. 2022 Sep 27;11(19):5725. doi: 10.3390/jcm11195725.
Pregnancy with chronic kidney disease is challenging, and patients with diabetic nephropathy are at particular risk of a rapid kidney function decline during pregnancy. While indications for the management of pregnant patients with initial diabetic nephropathy are widely available in the literature, data on patients with severe nephrotic syndrome and kidney function impairment are lacking, and the decision on whether and when dialysis should be initiated is not univocal. We report a type 1 diabetes patient who started pregnancy with a severe nephrotic syndrome and shifted from CKD stage 3b to stage 5 during pregnancy. The management was complicated by a fetal heart malformation and by poorly controlled diabetes. The evidence for and against starting dialysis was carefully evaluated, and the choice of strict nephrological and obstetrical monitoring, nutritional management, and diuretic treatment made it possible to avoid dialysis in pregnancy, after ruling out pre-eclampsia. This experience enables examination of some open issues and contributes to the discussion of when to start dialysis in pregnancy.
慢性肾脏病患者怀孕具有挑战性，糖尿病肾病患者在孕期肾功能迅速下降的风险尤其高。虽然文献中广泛提供了初始糖尿病肾病孕妇的管理指征，但缺乏关于重度肾病综合征和肾功能损害患者的数据，且关于是否以及何时应开始透析的决定并不明确。我们报告了一名1型糖尿病患者，她在怀孕时患有重度肾病综合征，孕期从慢性肾脏病3b期转变为5期。管理过程因胎儿心脏畸形和糖尿病控制不佳而变得复杂。我们仔细评估了支持和反对开始透析的证据，通过严格的肾脏病和产科监测、营养管理以及利尿剂治疗，在排除子痫前期后，成功避免了孕期透析。这一经验有助于探讨一些未解决的问题，并为讨论孕期何时开始透析做出贡献。
