Clinical features and prognosis of pregnancy-related renal damage and pregnancy after chronic kidney disease

Abstract

Abstract Objective: Explore the different clinical features of pregnancy-related renal damage and pregnancy after chronic kidney disease(CKD), so as to provides the clinical basis for the relationship between renal damage and pregnancy. Methods:Retrospective analysis the patients with pregnancy and kidney damage admitted to our hospital between March 2013 and February 2021. Collect the pathology results of renal biopsy, 24-hour urinary protein quantity, albumin(Alb), serum creatinine（Scr）, blood lipids, coagulation function, blood routine and other indicators during pregnancy and postpartum period. Results: A total of 82 cases were included in this study, including 48 cases in pregnancy-related renal damage group, of which 11 cases (22.92%) were terminated pregnancy. 34 cases in the post-CKD pregnancy group, of which 1 case (2.94%) were terminated pregnancy. There were 30 cases (88.24%) of CKD stage 1-2, the pregnancy outcome and fetal outcome were better in the post-CKD pregnancy group than in the pregnancy-related renal damage group (Ρ was 0.029, 0.036 respectively), there was no statistical significance in the comparison of fetal weight between the two groups (Ρ>0.05). In renal biopsy pathology, 16 cases (33.33%) were mainly focal segmental glomerulosclerosis (FSGS) in the pregnancy-related renal damage group, the post-CKD pregnancy group was dominated by 14 cases (43.75%) of IgA nephropathy. Comparison of the first indicators of pregnancy between the two groups showed that estimated glomerular filtration（eGFR）and Alb in the pregnancy-related renal damage group were lower than those in the post-CKD pregnancy group (Ρ was 0.003, 0.000 respectively). Meanwhile, 24-hour urinary protein quantity, total cholesterol（Tch）, triglyceride(TG), and platelet (PLT) counts were higher than the post-CKD pregnancy group (Ρ was 0.005, 0.001, 0.008, 0.031 respectively). The abnormal rate of Scr during pregnancy was 41.67% (20/48) in the pregnancy-related renal damage group, 17.39% (4/23) in the post-CKD pregnancy group, and the abnormal rate of Scr during pregnancy in the two groups was statistically significant (Ρ was 0.043 respectively). Conclusion: The pathological type of the pregnancy-related renal damage group is mainly FSGS, and the post-CKD pregnancy group is dominated by IgA nephropathy. Patients with stage CKD1-2 can have an active pregnancy after the well control of eGFR, albumin, 24-hour urinary protein quantity and other indicators, there are better pregnancy and fetal outcomes. Abnormal Scr during pregnancy of pregnancy-related renal damage can be improved after 3 months postpartum.