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综述

慢性肾脏病合并妊娠最新研究进展

  • 刘爱春 ,
  • 燕宇 ,
  • 左力
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  • 1. 北京大学人民医院 肾内科

收稿日期: 2019-06-06

  修回日期: 2019-06-13

  网络出版日期: 2019-08-15

Chronic kidney disease women complicated with pregnancy

  • LIU Ai-Chun ,
  • YAN Yu ,
  • ZUO Li
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  • 1Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China

Received date: 2019-06-06

  Revised date: 2019-06-13

  Online published: 2019-08-15

摘要

【摘要】随着慢性肾脏病(chronic kidney disease,CKD)发病率不断增加,CKD 合并妊娠的人数也越来越多。CKD 合并妊娠时,既存肾脏病可能对妊娠及胎儿产生不良影响,同时妊娠也会加重CKD 的进展。妊娠与CKD 的关系包括妊娠可能导致CKD 的恶化、进展,CKD 也可能增加各类妊娠相关并发症。如何评估CKD 患者的妊娠时机,并对妊娠过程进行监测和管理是临床医生和患者共同关心的问题。本文总结了近年来有关CKD 合并妊娠的最新进展,并详细介绍了几种常见肾脏病(如IgA 肾病、狼疮性肾炎、糖尿病肾病)合并妊娠的研究结果,同时总结了肾脏病相关药物在妊娠期间的调整原则。

本文引用格式

刘爱春 , 燕宇 , 左力 . 慢性肾脏病合并妊娠最新研究进展[J]. 中国血液净化, 2019 , 18(08) : 556 -559 . DOI: 10.3969/j.issn.1671-4091.2019.08.012

Abstract

【Abstract】The number of pregnant women with various degrees of renal dysfunction becomes increasing, as the incidence of chronic kidney disease (CKD) is going up worldwide. CKD and pregnancy are mutually affected, in which the pregnancy and fetus are adversely affected by the renal dysfunction, and the processes of CKD may deteriorate due to the pregnancy. Both clinicians and the patients are concerned about the appropriate time for pregnancy and how to monitor and manage the pregnancy in CKD women. In this review, we review the recent progresses in CKD women with pregnancy, introduce the outcomes of pregnancies and fetuses in women with several common nephropathies such as IgA nephrology, lupus nephritis and diabetic nephropathy, and summarize the protocols to adjust CKD-related drugs during pregnancy.

参考文献

[1]Piccoli GB, Cabiddu G, Attini R, et al.Risk of Adverse Pregnancy Outcomes in Women with CKD[J].J Am Soc Nephrol, 2015, 26(8):2011-2022
[2]Bramham K, Seed PT, Lightstone L, et al.Diagnostic and predictive biomarkers for pre-eclampsia in patients with established hypertension and chronic kidney disease[J].Kidney Int, 2016, 89(4):874-885
[3]Imbasciati E, Gregorini G, Cabiddu G, et al.Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes[J].Am J Kidney Dis, 2007, 49(6):753-762
[4]Liu Y, Ma X, Zheng J, et al.A Systematic Review and Meta-Analysis of Kidney and Pregnancy Outcomes in IgA Nephropathy[J].Am J Nephrol, 2016, 44(3):187-193
[5]Su X, Lv J, Liu Y, et al.Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy: A Cohort Study[J].Am J Kidney Dis, 2017, 70(2):262-269
[6]Zhang JJ, Ma XX, Hao L, et al.A Systematic Review and Meta-Analysis of Outcomes of Pregnancy in CKD and CKD Outcomes in Pregnancy[J].Clin J Am Soc Nephrol, 2015, 10(11):1964-1978
[7]Munkhaugen J, Lydersen S, Romundstad PR, et al.Kidney function and future risk for adverse pregnancy outcomes: a population-based study from HUNT II,Norway[J].Nephrol Dial Transplant, 2009, 24(12):3744-3750
[8]Wang F, Lu JD, Zhu Y, et al.Renal Outcomes of Pregnant Patients with Immunoglobulin A Nephropathy: A Systematic Review and Meta-Analysis[J].Am J Nephrol, 2019, 49(3):214-224
[9]Shimizu A, Takei T, Moriyama T, et al.Effect of Pregnancy and Delivery on the Renal Function and the Prognosis of Patients with Chronic Kidney Disease Stage 3 Caused by Immunoglobulin A Nephropathy[J].Intern Med, 2015, 54(24):3127-3132
[10]Oh HJ, Han SH, Yoo DE, et al.Reduced pre-pregnancy proteinuria is associated with improving postnatal maternal renal outcomes in IgA nephropathy women[J].Clin Nephrol, 2011, 76(6):447-454
[11]叶文玲, 史亚男, 文煜斌.肾病患者妊娠:年回顾性分析[J].中华肾脏病杂志, 2016, 32(9):641-646
[12]Liu Y, Ma X, Lv J, et al.Risk factors for pregnancy outcomes in patients with IgA nephropathy: a matched cohort study[J].Am J Kidney Dis, 2014, 64(5):730-736
[13]Moroni G, Ponticelli C.Pregnancy in women with systemic lupus erythematosus (SLE)[J]. Eur J Intern Med, 2016, 32: 7-12. doi: 10.1016/j.ejim.2016.04.005
[14]Buyon JP, Kim MY, Guerra MM, et al.Predictors of Pregnancy Outcomes in Patients With Lupus: A Cohort Study[J].Ann Intern Med, 2015, 163(3):153-163
[15]Attia DH, Mokbel A, Haggag HM, et al.Pregnancy outcome in women with active and inactive lupus nephritis: A prospective cohort study[J]. Lupus, 2019: 961203319846650. doi: 10.1177/0961203319846650
[16]Wu J, Zhang WH, Ma J, et al.Prediction of fetal loss in Chinese pregnant patients with systemic lupus erythematosus: a retrospective cohort study[J].BMJ Open, 2019, 9(2):e023849-
[17]Moroni G, Doria A, Giglio E, et al.Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study[J]. J Autoimmun, 2016, 74: 194-200. doi: 10.1016/j.jaut.2016.06.012
[18]Bramham K.Diabetic Nephropathy and Pregnancy[J].Semin Nephrol, 2017, 37(4):362-369
[19]Nielsen LR, Damm P, Mathiesen ER.Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy?[J].Diabetes Care, 2009, 32(1):38-44
[20]Damm JA, Asbjornsdottir B, Callesen NF, et al.Diabetic nephropathy and microalbuminuria in pregnant women with type 1 and type 2 diabetes: prevalence,antihypertensive strategy,and pregnancy outcome[J].Diabetes Care, 2013, 36(11):3489-3494
[21]Spotti D.Pregnancy in women with diabetic nephropathy[J].J Nephrol, 2019, 32(3):379-388
[22]Ringholm L, Damm JA, Vestgaard M, et al.Diabetic Nephropathy in Women With Preexisting Diabetes: From Pregnancy Planning to Breastfeeding[J].Curr Diab Rep, 2016, 16(2):12-
[23]Bateman BT, Patorno E, Desai RJ, et al.Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations[J].Obstet Gynecol, 2017, 129(1):174-184
[24]Ahmed B, Tran DT, Zoega H, et al.Maternal and perinatal outcomes associated with the use of renin-angiotensin system (RAS) blockers for chronic hypertension in early pregnancy[J]. Pregnancy Hypertens, 2018, 14: 156-161. doi: 10.1016/j.preghy.2018.09.010
[25]Wiles KS, Nelson-Piercy C, Bramham K.Reproductive health and pregnancy in women with chronic kidney disease[J].Nat Rev Nephrol, 2018, 14(3):165-184
[26]Seo MR, Chae J, Kim YM, et al.Hydroxychloroquine treatment during pregnancy in lupus patients is associated with lower risk of preeclampsia[J].Lupus, 2019, 28(6):722-730
[27]Bitencourt N, Bermas BL.Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception,Pregnancy and Breastfeeding[J].Paediatr Drugs, 2018, 20(6):511-521
[28]Gotestam Skorpen C, Hoeltzenbein M, Tincani A, et al.The EULAR points to consider for use of antirheumatic drugs before pregnancy,and during pregnancy and lactation[J].Ann Rheum Dis, 2016, 75(5):795-810
[29]Nakagawa K, Kwak-Kim J, Kuroda K, et al.Immunosuppressive treatment using tacrolimus promotes pregnancy outcome in infertile women with repeated implantation failures[J]. Am J Reprod Immunol, 2017, 78(3). doi: 10.1111/aji.12682
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