+1 Recommend
0 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.


          Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women.

          Related collections

          Most cited references 157

          • Record: found
          • Abstract: found
          • Article: not found

          International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS).

          New clinical, laboratory and experimental insights, since the 1999 publication of the Sapporo preliminary classification criteria for antiphospholipid syndrome (APS), had been addressed at a workshop in Sydney, Australia, before the Eleventh International Congress on antiphospholipid antibodies. In this document, we appraise the existing evidence on clinical and laboratory features of APS addressed during the forum. Based on this, we propose amendments to the Sapporo criteria. We also provide definitions on features of APS that were not included in the updated criteria.
            • Record: found
            • Abstract: found
            • Article: not found

            KDIGO clinical practice guideline for the care of kidney transplant recipients.

            The 2009 Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline on the monitoring, management, and treatment of kidney transplant recipients is intended to assist the practitioner caring for adults and children after kidney transplantation. The guideline development process followed an evidence-based approach, and management recommendations are based on systematic reviews of relevant treatment trials. Critical appraisal of the quality of the evidence and the strength of recommendations followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. The guideline makes recommendations for immunosuppression, graft monitoring, as well as prevention and treatment of infection, cardiovascular disease, malignancy, and other complications that are common in kidney transplant recipients, including hematological and bone disorders. Limitations of the evidence, especially on the lack of definitive clinical outcome trials, are discussed and suggestions are provided for future research.
              • Record: found
              • Abstract: found
              • Article: not found


              Pre-eclampsia affects 3-5% of pregnancies and is traditionally diagnosed by the combined presentation of high blood pressure and proteinuria. New definitions also include maternal organ dysfunction, such as renal insufficiency, liver involvement, neurological or haematological complications, uteroplacental dysfunction, or fetal growth restriction. When left untreated, pre-eclampsia can be lethal, and in low-resource settings, this disorder is one of the main causes of maternal and child mortality. In the absence of curative treatment, the management of pre-eclampsia involves stabilisation of the mother and fetus, followed by delivery at an optimal time. Although algorithms to predict pre-eclampsia are promising, they have yet to become validated. Simple preventive measures, such as low-dose aspirin, calcium, and diet and lifestyle interventions, show potential but small benefit. Because pre-eclampsia predisposes mothers to cardiovascular disease later in life, pregnancy is also a window for future health. A collaborative approach to discovery and assessment of the available treatments will hasten our understanding of pre-eclampsia and is an effort much needed by the women and babies affected by its complications.

                Author and article information

                J Clin Med
                J Clin Med
                Journal of Clinical Medicine
                05 November 2018
                November 2018
                : 7
                : 11
                [1 ]Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy
                [2 ]Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France; biancacovella@
                [3 ]Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia; helena.zakharova@
                [4 ]Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia
                [5 ]Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia
                [6 ]Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy; rossella.attini@
                [7 ]Nephrology Service, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, University of Guadalajara Health Sciences Center, Guadalajara, Jal 44100, Mexico; maribaher@ (M.I.-H.); ggarcia1952@ (G.G.-G.)
                [8 ]Instituto Nacional de Perinatologia, Mexico D.F. 01020, Mexico; ale_gaba@
                [9 ]Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE; mona_539@
                [10 ]National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China; zhihong--liu@
                [11 ]Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon; maglo09@
                [12 ]Nefrologia Ospedale Brotzu, 09100 Cagliari, Italy; gianfranca.cabiddu@
                [13 ]Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong; philipli@
                [14 ]Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; alevin@
                Author notes
                [* ]Correspondence: gbpiccoli@ ; Tel.: +33-669-733-371
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (



                Comment on this article