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肾病范围蛋白尿女性的妊娠：一项回顾性队列研究。

Pregnancy in women with nephrotic-range proteinuria: A retrospective cohort study.

作者信息

Svetitsky Shuli, Lightstone Liz, Wiles Kate

机构信息

Imperial College Healthcare NHS Trust Renal and Transplant Centre, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.

Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, United Kingdom of Great Britain and Northern Ireland.

出版信息

Obstet Med. 2024 Jun;17(2):96-100. doi: 10.1177/1753495X231201896. Epub 2023 Oct 9.

DOI:10.1177/1753495X231201896
PMID:38784182
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11110743/
Abstract

BACKGROUND

Obstetric and kidney outcomes following detection of nephrotic-range proteinuria in early pregnancy have not been well described.

METHODS

A retrospective cohort study of chronic kidney disease (CKD) in pregnancy between 2008 and 2018. Outcomes in those with nephrotic-range proteinuria before 20 weeks' gestation were compared to those without nephrotic-range proteinuria.

RESULTS

The study included 37 women with nephrotic-range proteinuria and 62 women without. Pre-pregnancy estimated glomerular filtration rate (eGFR) was similar. Nephrotic-range proteinuria was associated with higher rates of preterm (odds ratio [OR] 1.77, 95% confidence interval [CI]: 1.07-2.92) and early preterm delivery (OR 2.63, 95% CI: 1.12-6.2), and with a requirement for renal replacement therapy at 3 years post-partum (OR 10.72, 95% CI: 2.58-44.47). Tubulointerstitial scarring on kidney biopsy was associated with early preterm delivery and progression to advanced CKD, independent of pre-pregnancy eGFR.

CONCLUSION

Compared to CKD without nephrotic-range proteinuria, nephrotic-range proteinuria early in pregnancy is associated with higher rates of pre-term delivery and progression to advanced CKD.

摘要

背景

妊娠早期检测到肾病范围蛋白尿后的产科和肾脏结局尚未得到充分描述。

方法

对2008年至2018年期间妊娠合并慢性肾脏病（CKD）进行一项回顾性队列研究。将妊娠20周前出现肾病范围蛋白尿的患者与未出现肾病范围蛋白尿的患者的结局进行比较。

结果

该研究纳入了37例肾病范围蛋白尿患者和62例无肾病范围蛋白尿患者。孕前估计肾小球滤过率（eGFR）相似。肾病范围蛋白尿与早产（比值比[OR]1.77，95%置信区间[CI]：1.07 - 2.92）和早期早产（OR 2.63，95%CI：1.12 - 6.2）发生率较高相关，并且与产后3年需要肾脏替代治疗相关（OR 10.72，95%CI：2.58 - 44.47）。肾活检的肾小管间质瘢痕与早期早产和进展为晚期CKD相关，独立于孕前eGFR。

结论

与无肾病范围蛋白尿的CKD相比，妊娠早期肾病范围蛋白尿与更高的早产率和进展为晚期CKD相关。