Jesudason Shilpanjali, Safi Nadom, Li Zhuoyang, Brown Mark, Hague William, Makris Angela, McDonald Stephen, Peek Michael J, Sullivan Elizabeth
Pregnancy and Kidney Research Australia, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital and Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
Aust N Z J Obstet Gynaecol. 2025 Apr;65(2):227-234. doi: 10.1111/ajo.13885. Epub 2024 Sep 27.
Current understanding of clinical practice and care for maternal kidney disease in pregnancy in Australia is hampered by limitations in available renal-specific datasets.
To capture the epidemiology, management, and outcomes of women with significant kidney disease in pregnancy and demonstrate feasibility of a national cohort study approach.
An Australian prospective study (2017-2018) using a new kidney disease-specific survey within the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with acute kidney injury (AKI), advanced chronic kidney disease (CKD), dialysis dependence or a kidney transplant were included. Demographic data, renal and obstetric management, and perinatal outcomes were collected.
Among 58 case notifications from 12 hospitals in five states, we included 23 cases with kidney transplant (n = 12), pre-existing CKD (n = 8), newly diagnosed CKD (n = 2) and dialysis (n = 1). No cases of AKI were reported. Reporting rates were better in states with study investigators and, overall, cases were likely under-reported. Nearly 35% of women had a non-delivery-related antenatal admission. Nephrology involvement was 78.3% during pregnancy and 91% post-partum. Adverse events were increased, including pre-eclampsia (21.7%), and preterm birth (60.9%). Women had high rates of aspirin (82.6%) and antihypertensive (73.9%) use, indwelling catheter for labour/delivery (65.2%), caesarean delivery (60.9%), and blood transfusion (21.7%).
This first-ever Australian prospective study of significant kidney diseases in pregnancy provided novel insights into renal-specific clinical patterns and practices. However, under-reporting was likely. Future studies need to overcome the challenges of case identification and data collection burden.
澳大利亚目前对妊娠期母体肾脏疾病的临床实践和护理的理解因可用的肾脏特异性数据集的局限性而受到阻碍。
了解妊娠期患有严重肾脏疾病的女性的流行病学、管理情况及结局，并证明全国队列研究方法的可行性。
一项澳大利亚前瞻性研究（2017 - 2018年），在澳大拉西亚孕产妇结局监测系统（AMOSS）内使用一项新的肾脏疾病特异性调查。纳入分娩时患有急性肾损伤（AKI）、晚期慢性肾病（CKD）、透析依赖或肾移植的女性。收集人口统计学数据、肾脏和产科管理情况以及围产期结局。
在来自五个州12家医院的58例病例报告中，我们纳入了23例肾移植病例（n = 12）、既往存在的CKD病例（n = 8）、新诊断的CKD病例（n = 2）和透析病例（n = 1）。未报告AKI病例。有研究人员的州报告率更高，总体而言，病例可能报告不足。近35%的女性有与分娩无关的产前入院。妊娠期间肾病科参与率为78.3%，产后为91%。不良事件增加，包括子痫前期（21.7%）和早产（60.9%）。女性使用阿司匹林（82.6%）和抗高血压药物（73.9%）的比例很高，分娩时留置导管（65.2%）、剖宫产（60.9%）和输血（21.7%）的比例也很高。
这项澳大利亚首次针对妊娠期严重肾脏疾病的前瞻性研究为肾脏特异性临床模式和实践提供了新的见解。然而，可能存在报告不足的情况。未来的研究需要克服病例识别和数据收集负担方面的挑战。
