Abstract
Chronic kidney disease (CKD) affects 3% of pregnancies, impacting on maternal and fetal outcomes, and at the same time, a recurrent question in nephrology regards gestation impact on kidney function. Observational studies stated that CKD stage, pre-existent hypertension, and proteinuria are the main predictors of possible complications, such as maternal CKD progression, maternal or fetal death, prematurity, small for gestational age (SGA) newborn, or admission to the neonatal intensive care unit. In this regard, given the prominence of proteinuria among other risk factors, we focused on primary nephrotic syndrome in pregnancy, which accounts for 0.028% of cases, and its impact on materno-fetal outcomes and kidney survival. Data extracted from literature are scattered because of the small cohorts investigated in each trial. However, they showed different outcomes for each glomerular disease, with membranous nephropathy (MN) having a better maternal and fetal prognosis than focal and segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), or minimal change disease (MCD). Nephrotic syndrome does not have to discourage women to undertake a pregnancy, but the correct management may include a specific evaluation of risk factors and follow-up for adverse materno-fetal events and/or maternal kidney disease progression.
Highlights
In the past, fear of chronic kidney disease (CKD) progression could prevent nephrologists from sustaining their female patients’ idea of conceiving or carrying on gestation, even if evidence of adverse outcomes was scattered
The aim of our review is to investigate the outcomes of women affected by nephrotic syndrome due to primary glomerulopathies, including focal and segmental glomerulosclerosis (FSGS), minimal change disease (MCD), membranous nephropathy (MN), and membranoproliferative glomerulonephritis (MPGN)
Statistical analysis of maternofetal or kidney outcomes in those trials is often based on CKD stage rather than on the specific underlying causes that range from hypertension and/or proteinuria, diabetic nephropathy (DN), and glomerulonephritis to autosomal dominant polycystic kidney disease (ADPKD), kidney malformations, nephrolithiasis, or chronic urinary tract infections (UTIs)
Summary
Observational studies stated that CKD stage, pre-existent hypertension, and proteinuria are the main predictors of possible complications, such as maternal CKD progression, maternal or fetal death, prematurity, small for gestational age (SGA) newborn, or admission to the neonatal intensive care unit. In this regard, given the prominence of proteinuria among other risk factors, we focused on primary nephrotic syndrome in pregnancy, which accounts for 0.028% of cases, and its impact on materno-fetal outcomes and kidney survival.
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