Analysis of the course and outcomes of pregnancy in patients with advanced stages chronic kidney disease
- Authors: Demyanova K.A.1,2, Kozlovskaya N.L.1,2, Korotchaeva Y.V.2,3, Apresyan S.V.1,2, Rylceva L.P.1, Usatenko G.V.2, Lugovoj A.O.2, Vorobyeva M.A.1,2, Bondarenko T.V.2, Bespalova A.V.2, Volkova O.A.2
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Affiliations:
- People’s Friendship University of Russia
- Eramishantsev City Clinical Hospital
- Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 93, No 6 (2021)
- Pages: 685-692
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/75950
- DOI: https://doi.org/10.26442/00403660.2021.06.200867
- ID: 75950
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Abstract
Background. Pregnancy in patients with advanced chronic kidney disease (CKD) is associated with a high risk of adverse outcomes for the mother and the fetus, but data on the characteristics of the course of pregnancy in these women is limited.
Aim. To analyse of the course and outcomes of pregnancy in patients with CKD stages 3a–4.
Materials and methods. Thirty five pregnant women with CKD stages 3–4 were included: 3a – 12 (34.3%) patients, stage 3b – 10 (28.6%), stage 4 – 13 (37.1%).
Results. Proteinuria, serum creatinine, blood pressure in dynamics, the presence of a physiological response were investigated. Pregnancy management included blood pressure correction, antianemic, antiplatelet, anticoagulant therapy, prevention and treatment of urinary infection, correction of metabolic disorders. All pregnant women had proteinuria of varying severity, which increased towards the end of pregnancy. Seventeen (51.5%) patients had hypertension, successfully corrected with antihypertensive drugs. The average delivery term was 34.6 weeks. Preeclampsia developed in 14 (42.4%) cases, an inverse relationship was found between the presence of a physiological response and preeclampsia (p=0.009; rs=-0.463). All children were born alive and viable. After delivery in patients with CKD 3a creatinine values returned to the pre-gestational level, in patients with grade 3b and 4 progression of CKD was noted.
Conclusion. A favorable pregnancy outcome in women with late stages of CKD is possible with constant monitoring by a multidisciplinary team of doctors with mandatory monitoring of renal function, proteinuria, blood pressure, coagulation, markers of preeclampsia and indicators of fetal health. It was proposed to consider the physiological response of the kidneys to pregnancy as a predictor of a favorable outcome.
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##article.viewOnOriginalSite##About the authors
Kseniia A. Demyanova
People’s Friendship University of Russia; Eramishantsev City Clinical Hospital
Author for correspondence.
Email: ksedem@gmail.com
ORCID iD: 0000-0001-8927-5841
канд. мед. наук, ассистент каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, Moscow; MoscowNatalia L. Kozlovskaya
People’s Friendship University of Russia; Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-4275-0315
д-р мед. наук, проф., проф. каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, рук. Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, Moscow; MoscowYuliia V. Korotchaeva
Eramishantsev City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University)
Email: ksedem@gmail.com
ORCID iD: 0000-0002-0880-6346
канд. мед. наук, доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет), врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, Moscow; MoscowSergei V. Apresyan
People’s Friendship University of Russia; Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-7310-974X
д-р мед. наук, проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН, зам. глав. врача по акушерско- гинекологической помощи ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, Moscow; MoscowLidiia P. Rylceva
People’s Friendship University of Russia
Email: ksedem@gmail.com
ORCID iD: 0000-0001-6153-360X
студентка лечебного фак-та ФГАОУ ВО РУДН
Russian Federation, MoscowGalina V. Usatenko
Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0003-4057-0190
зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, MoscowArtem O. Lugovoj
Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-3344-7891
зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, MoscowMariia A. Vorobyeva
People’s Friendship University of Russia; Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-6932-2054
канд. мед. наук, ассистент каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, врач- терапевт ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, Moscow; MoscowTatiana V. Bondarenko
Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0003-0701-1805
зав. отд-нием ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, MoscowAnna V. Bespalova
Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-6993-6291
врач-нефролог ГБУЗ «ГКБ им. А.К. Ерамишанцева»
Russian Federation, MoscowOlga A. Volkova
Eramishantsev City Clinical Hospital
Email: ksedem@gmail.com
ORCID iD: 0000-0002-1996-2133
врач-нефролог ГБУЗ «ГКБ им. А.К. Ерамишанцева»
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