Pregnancy in chronic kidney disease.

Area of Science:

• Nephrology
• Obstetrics
• Maternal-Fetal Medicine

Background:

• Pregnancy in women with chronic kidney disease (CKD) presents significant risks, including renal function decline and adverse outcomes like preeclampsia and preterm birth.
• Accurate glomerular filtration rate (GFR) estimation and the predictive value of current CKD classification systems in pregnant populations remain unclear.

Purpose of the Study:

• To review the challenges and management strategies for pregnant women with CKD.
• To highlight diagnostic difficulties and potential biomarkers for preeclampsia in this population.
• To discuss specific considerations for conditions like lupus nephritis, adult polycystic kidney disease, and diabetic nephropathy during pregnancy.

Main Methods:

• Literature review and synthesis of current knowledge on CKD in pregnancy.
• Discussion of diagnostic tools and therapeutic agents relevant to pregnant women with kidney disease.
• Emphasis on the importance of multidisciplinary care involving nephrologists and obstetricians.

Main Results:

• Women with estimated GFR ≥1.4 mg/dL face increased risk of renal function deterioration.
• Serum markers like sFlt1 and PIGF show promise for diagnosing preeclampsia in CKD patients.
• Cyclosporine is a safe and effective treatment for lupus nephritis during pregnancy.
• Adult polycystic kidney disease and diabetic nephropathy require specific management, including strict blood pressure control.

Conclusions:

• Managing pregnant women with CKD necessitates a comprehensive, team-based approach.
• Early diagnosis and tailored interventions are crucial for improving maternal and fetal outcomes.
• Further research is needed for accurate GFR estimation and outcome prediction using CKD classifications.