Department of Nephrology, First affiliated hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
Department of Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, NO.1 Jiankang Street,Yuzhong District, Chongqing, 400014, China.
BMC Pregnancy Childbirth. 2023 Aug 29;23(1):619. doi: 10.1186/s12884-023-05941-7.
To explore the clinical features of renal damage related to pregnancy and pregnancy after chronic kidney disease (CKD), providing clinical evidence for the relationship between renal damage and pregnancy.
A retrospective analysis was performed on patients admitted to our hospital between March 2013 and February 2021 who had both pregnancy and kidney damage. The study collected pathology results from renal biopsies, 24-hour urinary protein quantity, albumin (Alb), serum creatinine (Scr), blood lipids, coagulation function, blood routine, and other indicators during and after pregnancy.
This study included 82 cases, with 48 cases in the pregnancy-related renal damage group. Thirty-four cases were in the post-CKD pregnancy group. Of the patients, 30 cases (88.24%) had CKD stage 1-2. Results showed better pregnancy and fetal outcomes in the post-CKD pregnancy group compared to the pregnancy-related renal damage group (Ρ was 0.029 and 0.036, respectively). Renal biopsy pathology revealed that 16 cases (33.33%) in the pregnancy-related renal damage group mainly had focal segmental glomerulosclerosis (FSGS), while the post-CKD pregnancy group was dominated by 14 cases (43.75%) of IgA nephropathy. The first blood test indicators revealed that the pregnancy-related renal damage group had lower estimated glomerular filtration (eGFR) and Alb levels compared to the post-CKD pregnancy group (Ρ was 0.003 and 0.000, respectively). Additionally, 24-hour urinary protein quantity, total cholesterol (Tch), triglyceride (TG), and platelet (PLT) counts were higher in the pregnancy-related renal damage group compared to the post-CKD pregnancy group (Ρ was 0.005, 0.001, 0.008, and 0.031, respectively). The abnormal rate of Scr during pregnancy was 41.67% (20/48) in the pregnancy-related renal damage group and 17.39% (4/23) in the post-CKD pregnancy group, with a statistically significant difference (Ρ was 0.043).
The pregnancy-related renal damage group is mainly associated with FSGS, while the post-CKD pregnancy group is characterized by IgA nephropathy. Patients with CKD1-2 can have a successful pregnancy after achieving good control of eGFR, albumin, 24-hour urinary protein quantity and other indicators, resulting in better pregnancy and fetal outcomes. Abnormal Scr levels during pregnancy of pregnancy-related renal damage can be improved within 3 months after delivery.
探讨妊娠相关肾损伤和慢性肾脏病（CKD）后妊娠的临床特点，为肾损伤与妊娠的关系提供临床依据。
回顾性分析 2013 年 3 月至 2021 年 2 月在我院住院且妊娠合并肾损伤的患者，收集患者肾活检病理结果、24 小时尿蛋白定量、白蛋白（Alb）、血肌酐（Scr）、血脂、凝血功能、血常规等妊娠前后的指标。
本研究共纳入 82 例患者，其中妊娠相关肾损伤组 48 例，CKD 后妊娠组 34 例，患者中 CKD1-2 期占 30 例（88.24%）。CKD 后妊娠组妊娠及胎儿结局优于妊娠相关肾损伤组（Ρ值分别为 0.029、0.036）。肾活检病理结果显示，妊娠相关肾损伤组以局灶节段性肾小球硬化（FSGS）为主，有 16 例（33.33%），而 CKD 后妊娠组以 IgA 肾病为主，有 14 例（43.75%）。首次化验指标中，妊娠相关肾损伤组 eGFR、Alb 水平低于 CKD 后妊娠组（Ρ值分别为 0.003、0.000），24 小时尿蛋白定量、总胆固醇（Tch）、三酰甘油（TG）、血小板（PLT）计数高于 CKD 后妊娠组（Ρ值分别为 0.005、0.001、0.008、0.031）。妊娠相关肾损伤组 Scr 异常率为 41.67%（20/48），CKD 后妊娠组为 17.39%（4/23），两组比较差异有统计学意义（Ρ值为 0.043）。
妊娠相关肾损伤组以 FSGS 为主，而 CKD 后妊娠组以 IgA 肾病为主。CKD1-2 患者在 eGFR、Alb、24 小时尿蛋白定量等指标控制良好后可获得良好的妊娠结局，妊娠及胎儿结局更好。妊娠相关肾损伤组妊娠期间 Scr 异常可在产后 3 个月内改善。
