Influence of Pregnancy on Renal Function and Feturs in Women with Underlying Renal Disease
PURPOSE: The interaction of kidney disease and pregnancy outcome and the effect of pregnancy on the natural course of maternal renal disease continues to be debated. There have been many reports published in Western countries on this issue; however there is limited data in Korea. In this study, we investigated the effect of pregnancy on renal function in women with underlying renal disease and also evaluated the effect on the fetus. METHODS: We performed a retrospective study on 41 pregnancies in 34 patients at the Ajou University Hospital from June 1994 through February 2006 who had been diagnosed glomerular disease by renal biopsy or were suspected as having glomerulonephritis. We analyzed changes in serum creatinine, random urine protein / creatinine, blood pressure, fetal status, and the pregnancy outcome each at the preconception state, at a three months minimum after delivery, and finally at one year follow-up after delivery. RESULTS: In the group with a preconception glomerular filtration rate exceeding 60 ㎖/min/1.73m2 (n=31) compared to the group with lower than 60 ㎖/min/1.73m2 (n=10), cases where the renal function deteriorated after delivery were three (9.7%) and five (50.0%) respectively. The group with preconception proteinuria less than 3.5 g/day (n=24) compared to the group that had levels exceeding 3.5 g/day (n=9), the cases where renal function deteriorated after delivery were two (8.3%) and four (44.4%) respectively. In the group with normal blood pressure before pregnancy (n=22) there was one case (4.5%) with deteriorated renal function after delivery compared to the hypertensive group (n=19) where seven cases (36.8%) had deteriorated of renal function after delivery. By the multivariate logistic regression analysis the factors that predicted renal function after delivery included: the preconception glomerular filtration rate, presence of hypertension, and the presence of proteinuria 3.5 g/day. Our findings suggest that the preconception glomerular filtration rate was the most important factor that significantly associated with renal function after delivery. In the group that the glomerular filtration rate prior to pregnancy was less than 60 ㎖/min/1.73m2, abnormal fetal condition was six cases (66.7%) and abnormal delivery was seven cases (70.0%), which appears to mediate effects greatly, nonetheless, it was not statistically significant. CONCLUSIONS: The results of this study showed that patients with pre-existing glomerular disease that was complicated by reduced renal function, with a glomerular filtration rate less than 60 ㎖/min/1.73m2 before conception, had deterioration of renal function after delivery.
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