119. The management of pregnant women with chronic kidney disease: An 8-year review in a tertiary care center

Abstract

Objective The management and treatment of kidney disease has advanced, and women who are pregnant and give birth have also increased recently. On the other hand, pregnancy with kidney disease causes preeclampsia (19–30%), intrauterine fetal death (16–20%), postpartum renal failure (3–5%). The purpose of this study was to review the maternal and neonatal outcomes in pregnant women with chronic kidney disease (CKD), and to evaluate the appropriate management that may contribute to obstetric outcomes. Methods We conducted a retrospective review of 126 births and 129 neonates in 110 CKD patients who were seen at Osaka University Hospital between January, 2010, and December, 2017. Results The mean patient age was 33.5 (18–49) years, and the nulliparity rate was 61%. The most frequent disease was IgA nephropathy (43/126; 34%) and the second was lupus nephritis and renal transplantation (both were 15/126; 12%). Second trimester abortion and preterm delivery occurred in 5% and 20% of the patients, respectively. There was no maternal and neonatal death. Fetal growth restriction and preeclampsia occurred in 10% and 25% of the patients, respectively. Two patients with lupus nephritis and one with Henoch-Schonlein purpura nephritis had severe preeclampsia occurred before 20 weeks gestation. sFlt1/PlGF ratio were 427, 865 and 1183, respectively. Conclusions To predict and prevent the adverse events in the care of pregnant women with CKD is important for good maternal and neonatal outcomes. Furthermore, Henoch-Schonlein purpura nephritis that had been already ameliorated may be also a risk factor for severe preeclampsia.