#5009 GESTATIONAL COUNSELING DURING PREGNANCY IN PATIENTS WITH KIDNEY DISEASE: EXPERIENCE OF A MULTIDISCIPLINARY TEAM
Authors: Brito María Verónica Coll , Redondo Gerson Berna , Lopez Berta Magallares , Olivé Elisa Llurba , Barros Xoana , Dominguez Anna , Bardaji Beatriz , Guirado Lluis , Encarnacion Monserrat Diaz , Rusiñol Helena Marco 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease increases morbidity and mortality in pregnancy, being more prone to complications. Because it confers a risk to the fetus, this group of patients should be evaluated by a multidisciplinary unit, including nephrologists, rheumatologists, and obstetricians. Our study's objective is to describe the clinical/analytical characteristics of patients with kidney disease (KD), assessed in a multidisciplinary consultation, to inform them of the risks and to be able to prepare them to reach pregnancy optimally. At the same time, detect patients with increased risk of complications and perform close follow-ups during pregnancy and postpartum.

Method
Demographic, clinical, analytical, and obstetric variables were collected in a retrospective study that included women with kidney disease (inflammatory/autoimmune) between May 2020 to March 2022. In our hospital, the hereditary kidney disease unit offers reproductive advice to its patients, which was not considered in this study.

Results
A total of 24 patients with a median age of 35 years (18-39) were evaluated, classifying them into two independent groups: 1-pre-pregnancy (N=12) and 2-during pregnancy (N=12) and postpartum (N=10). All patients from group 1 have kidney disease (100%). Lupus nephropathy (LN) was the most frequent (64%), followed by minimal change disease (17%) and IgA nephropathy (9%). Maternal-fetal risks were evaluated according to clinical and analytical parameters (age, blood pressure, renal function, proteinuria, and disease activity, among others). 17% of patients had a history of high blood pressure. Treatment modification was made in 25%. Renal biopsy was performed in 4/7 LN patients, and pregnancy was not recommended for one of them (class III LN). In group 2, 14% of the patients presented onset KD (one patient presented de novo nephrotic syndrome and another one, an atypical hemolytic uremic syndrome in the immediate postpartum), the rest of them had previous KD: IgA Nephropathy (25%), and minimal change disease (17%), were the most frequent. 8% of the patients had a history of high blood pressure, 25% of them received ACE/ARBs that were discontinued. There were no cases of preeclampsia/eclampsia. The average gestation time was 38.5 weeks, 6.7% &lt;37 weeks, and none &lt;34 weeks. All newborns weigh greater than 2.5 Kg (mean birth weight 3.42 Kg). There were three inductions (two due to diabetes and one due to an altered topographic record). One peri-gestational complication (premature rupture of membranes) and one perinatal complication (respiratory distress) were observed. No other recorded/evidenced complications.

Conclusion
The gestational counselling and monitoring during pregnancy provide adequate support for patients with KD, being able to carry out a "guided" pregnancy with fewer complications. The strategies of our unit include modification of pre-conception treatment, activity control of underlying pathologies, and monitoring of kidney disease during pregnancy to reduce the risk of miscarriages, premature births, and low birth weight, among other complications.