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Maternal kidney function during pregnancy: systematic review and meta-analysis.

V A Lopes van Balen1, T A G van Gansewinkel1, S de Haas1

  • 1Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|October 6, 2018
PubMed
Summary

Kidney function, specifically glomerular filtration rate (GFR), significantly increases during healthy pregnancies, starting in the first trimester. However, hypertensive disorders in pregnancy are associated with decreased kidney function compared to healthy pregnancies.

Keywords:
GFRestimated glomerular filtration rategestational hypertensive diseasekidney functionphysiologyplacental syndromepre-eclampsiapregnancyserum creatinine

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Area of Science:

  • Obstetrics and Gynecology
  • Renal Physiology
  • Reproductive Medicine

Background:

  • Pregnancy involves significant physiological adaptations, including changes in renal function.
  • Understanding these changes is crucial for distinguishing normal pregnancy from pathological conditions.
  • Establishing reference values for kidney function during pregnancy is essential for accurate clinical assessment.

Purpose of the Study:

  • To systematically review literature on kidney function changes during pregnancy.
  • To estimate the extent of renal adaptation in healthy and complicated singleton pregnancies.
  • To determine reference values for kidney function in healthy pregnancies.

Main Methods:

  • Systematic literature search of PubMed and EMBASE databases up to July 2017.
  • Inclusion of studies reporting non-pregnant reference values and pregnancy measurements of kidney function.
  • Assessment of glomerular filtration rate (GFR) via inulin clearance, creatinine clearance, and serum creatinine levels.
  • Meta-analysis using a random-effects model to calculate pooled mean differences.

Main Results:

  • Glomerular filtration rate (GFR) increases by 40-50% in physiological pregnancy from the first trimester.
  • Inulin clearance peaks at 36-41 weeks (55.6% increase), while creatinine clearance peaks at 15-21 weeks (37.6% increase).
  • Serum creatinine levels decrease by 23.2% in uncomplicated pregnancies.
  • Significant differences in kidney function parameters were observed between uncomplicated and hypertensive pregnancies.

Conclusions:

  • Kidney function, particularly GFR, is elevated throughout healthy gestation, beginning in the first trimester.
  • Renal function remains at a higher rate in healthy pregnancies compared to non-pregnant states.
  • Hypertensive disorders during pregnancy are associated with impaired kidney function.