The impact of chronic kidney disease on pregnancy
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Meca Daniela-Catalina , Vasilescu Sorin-Liviu ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Mehedintu Claudia ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Carp-Veliscu Andreea ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Edu Antoine ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Frincu Francesca ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Dumitrascu Mihai ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Petca Aida ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Cirstoiu Monica-Mihaela ,   Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Published: June 2022

Background. Renal chronic disease can be categorized as an uncommon pathology associated with pregnancy, with a real incidence difficult to estimate. The significant risk for adverse outcomes can be translated into a high degree of occurrence of preeclampsia, fetal growth restriction, preterm delivery, and, also, progression of underlying renal dysfunction. The purpose of the article is to review the data from specialty literature, regarding the correlation between renal function and the pregnancy’s prognosis, so the best management can be implemented to improve the outcomes. Material and methods. We performed a research project conducted in Emergency University Hospital in Bucharest, regarding the impact of chronic renal disease on maternal and fetal outcome. The retrospective and prospective study extends over a period of over 4 years, between 2017 and 2021 and it is currently ongoing with the involvement of the Nephrology Department, the Dialysis Department and the Medical Laboratory. Results. We enrolled 12 pregnant women diagnosed with chronic renal disease. In all cases included in this research the mean 1-minute Apgar Index was 7. The rate of cesarian section was 95%, due to severe preeclampsia in 58% cases, fetal bradycardia in 33.33% cases and placentae abruption in 8.66%. In our study the most frequent risk factor was systemic lupus erythematosus (25%). The risk factors associated with the progression of renal disease in pregnancy were age < 24 years, nephrotic syndrome, hypertension, hematocrit <= 26%, serum creatinine > 1.4 mg/dl, prednisone monotherapy. The blood urea nitrogen had an average of 57 mg/dl, ranging between 26 and 173 mg/dl. Conclusions. The prognosis of pregnancy-associated with renal chronic disease is burdened by the appearance of serious fetal and maternal complications. Thus, special regard should be given to the management of this pathology during pregnancy, so that therapeutic criteria can be easily adopted, taking into consideration that, nowadays, the diagnosis is still a challenge due to the overlapping psychological changes.