Adverse maternal and fetal outcomes in pregnant patients with chronic kidney disease. Presentation of two cases in our clinic and literature review

L. Grozavu-Arsene, S. Vasilescu, O. Munteanu, M. Cîrstoiu

Rezumat: Pregnancy incidence in patients affected by chronic kidney disease (CKD) is increasing, despite the fact that renal disease is associated with high maternal and fetal morbidity. From an obstetrical perspective, the main complications for the developing pregnancy are often represented by preeclampsia or preterm delivery, in addition to the progression of their underlying renal dysfunction on a continuously increasing physiologic demands. If a pregnancy is considered, preconception counseling is advised. The lower the stage of CKD, the safer it is to consider in conceiving; however, in recent years, pregnancy in advanced or end-stage renal disease (ESRD), while on dialysis, is not a rare event, as overall outcome for those with advanced CKD has improved over time. The final risk of negative maternal-fetal outcomes is inversely related to renal function and increases with proteinuria. A multidisciplinary approach involving obstetricians, nephrologists and also neonatologists is needed in order to improve pregnancy outcomes in women with chronic kidney disease. The frequency of nephrological and obstetrical examination for pregnant CKD patients should be individualized for each patient.
Cuvinte cheie: chronic kidney disease, pregnancy, preterm delivery, preeclampsia.