中期 eGFR 预测妊娠结局：一项观察性研究。

Midterm eGFR Predicts Pregnancy Outcomes: An Observational Study.

机构信息

Professor, Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences.

Professor, Department of Obstetrics and Gynecology, King George's Medical University.

出版信息

J Assoc Physicians India. 2022 Dec;70(12):11-12. doi: 10.5005/japi-11001-0164.

DOI:10.5005/japi-11001-0164

PMID:37355966

Abstract

INTRODUCTION

The hemodynamic adjustments during pregnancy play a pivotal role in sustaining the gestation, however, its clinical connotation on midterm renal hyperfiltration and its consequence on maternal and fetal outcomes need a greater appraisal. The present retrospective study looked into the midterm estimated glomerular filtration rate (eGFR) among pregnant females without overt pieces of evidence of chronic kidney disease (CKD) as a surrogate marker for midterm hyperfiltration and its implication on maternal and fetal outcomes.

MATERIALS AND METHODS

All pregnancies among females aged 18-50 years with available pregestational baseline serum creatinine were included in the study. Maternal renal hyperfiltration was expressed as the highest eGFR, using the creatinine clearance method. Its association with adverse maternal and fetal outcomes was assessed.

RESULTS

A total of 1,045 pregnancies were assessed during the study. According to midterm eGFR, among them, 65% of pregnancies showed midterm eGFR between 120 and 150, however, 4.3% of pregnancies had values more than 150 mL/min per 1.73 m2 . The risk of poor pregnancy outcome was observed for eGFR levels below and above the reference level of 120-150 mL/min per 1.73 m2 (1.97 for values ≥150 mL/min per 1.73 m2 , and 1.72 for 90-120 mL/min per 1.73 m2 ). Pregnancies with eGFR between 60 and 90 mL/min per 1.73 m2 had odds ratios (ORs) of 5.64.

CONCLUSION

A distinctive relationship was observed between the midterm eGFR and adverse pregnancy outcomes with the best outcomes for midterm eGFR levels between 120 and 150 mL/min per 1.73 m2 . Despite no apparent functional renal deterioration, a poor maternal hyperfiltration response may play a crucial impact on poor pregnancy outcomes.

摘要

简介

怀孕期间的血液动力学调整对于维持妊娠起着关键作用，然而，其在中期肾高滤过中的临床内涵及其对母婴结局的影响需要更深入的评估。本回顾性研究探讨了中期估计肾小球滤过率（eGFR）在没有明显慢性肾脏病（CKD）证据的孕妇中作为中期高滤过的替代标志物及其对母婴结局的影响。

材料和方法

本研究纳入了年龄在 18-50 岁之间、有孕前基线血清肌酐的女性的所有妊娠。用肌酐清除率法表示母体肾高滤过，即最高 eGFR。评估其与不良母婴结局的关系。

结果

本研究共评估了 1045 例妊娠。根据中期 eGFR，其中 65%的妊娠中期 eGFR 在 120-150 之间，但有 4.3%的妊娠 eGFR 值大于 150 mL/min/1.73 m2。eGFR 值低于和高于 120-150 mL/min/1.73 m2 的参考水平（eGFR 值≥150 mL/min/1.73 m2 的风险比[OR]为 1.97，90-120 mL/min/1.73 m2 的风险比为 1.72），妊娠结局不良的风险增加。eGFR 在 60-90 mL/min/1.73 m2 之间的妊娠，OR 为 5.64。