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Chronic renal disease and pregnancy

David G Reuter, Yuk Law, Wayne C Levy, Stephen P Seslar, R Eugene Zierler, Mark Ferguson, James Chattra, Tim McQuinn, Lenna L Liu, Mark Terry, Patricia S Coffey, Jane A Dimer, Coral Hanevold, Joseph T Flynn, F Bruder Stapleton
The morbidity and mortality associated with preeclampsia is staggering. The physiology of the Page kidney, a condition in which increased intrarenal pressure causes hypertension, appears to provide a unifying framework to explain the complex pathophysiology. Page kidney hypertension is renin-mediated acutely and ischemia-mediated chronically. Renal venous outflow obstruction also causes a Page kidney phenomenon, providing a hypothesis for the increased vulnerability of a subset of women who have what we are hypothesizing is a "renal compartment syndrome" due to inadequate ipsilateral collateral renal venous circulation consistent with well-known variation in normal venous anatomy...
September 15, 2016: Journal of the American Society of Hypertension: JASH
Sue Kildea, Sally Tracy, Juanita Sherwood, Fleur Magick-Dennis, Lesley Barclay
The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory)...
October 17, 2016: Medical Journal of Australia
Ozan Ünlü, Stephane Zuily, Doruk Erkan
Antiphospholipid syndrome (APS) is the association of thrombosis and/or pregnancy morbidity with antiphospholipid antibodies (aPL). Thirty to forty percent of systemic lupus erythematosus (SLE) patients are tested positive for aPL, which may have an impact on the SLE presentation, management, and prognosis. Compared with SLE patients without aPL, those with aPL have a higher prevalence of thrombosis, pregnancy morbidity, valve disease, pulmonary hypertension, livedo reticularis, thrombocytopenia, hemolytic anemia, acute/chronic renal vascular lesions, and moderate/severe cognitive impairment; worse quality of life; and higher risk of organ damage...
June 2016: Eur J Rheumatol
Biljana Gerasimovska Kitanovska, Vesna Gerasimovska, Vesna Livrinova
BACKGROUND: Alport syndrome is a genetic disease that progresses to chronic kidney failure, with X-linked, autosomal dominant or autosomal recessive type of inheritance. Women are generally carriers of the mutation and have a milder form of the disease. During pregnancy, they have an increased risk of impaired kidney function and preeclampsia. CASE PRESENTATION: A 27-year old woman, gravida 1, para 0, in her 23rd gestational week came to the outpatient unit of the University Clinic of Nephrology for the first time because of slowly progressing proteinuria and Alport syndrome...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Oscar Swift, Enric Vilar, Belinda Rahman, Lucy Side, Daniel P Gale
AIMS: No recommendations currently exist regarding implementation of both prenatal diagnosis and preimplantation genetic diagnosis (PGD) for autosomal dominant polycystic kidney disease (ADPKD). This study evaluated attitudes in ADPKD patients with either chronic kidney disease (CKD) stages I-IV or end-stage renal failure (ESRF) toward prenatal diagnosis and PGD. METHODS: Ninety-six ADPKD patients were recruited from an outpatient clinic, wards, and dialysis units...
September 30, 2016: Genetic Testing and Molecular Biomarkers
Mitsumasa Umesawa, Gen Kobashi
Hypertensive disorders in pregnancy (HDP) represent some of the most important problems faced by public health because HDP is a major cause of maternal and prenatal morbidity and mortality. Several epidemiological studies have been performed to determine the prevalence and risk factors of HDP as well as its subtypes. The prevalences of HDP, gestational hypertension and preeclampsia are 5.2-8.2%, 1.8-4.4% and 0.2-9.2%, respectively. Body mass index, anemia and lower education appear to be modifiable risk factors for HDP...
September 29, 2016: Hypertension Research: Official Journal of the Japanese Society of Hypertension
F Kleinclauss, M-O Timsit, R Thuret
AIMS: To describe sexuality and fertility alterations secondary to chronic kidney disease and their outcomes after renal transplantation. MATERIAL AND METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database ( and Embase ( using different associations of the following keywords: erectile dysfunction; impotence; sexuality; pregnancy; fertility; renal transplantation...
September 21, 2016: Progrès en Urologie
Ana Vrdoljak, Vanja Ivković, Sandra Karanović, Živka Dika, Ivana Vuković, Jelena Kos, Mario Laganović, Tajana Željković Vrkić, Margareta Fištrek Prlić, Ivan Pećin, Bojan Jelaković
OBJECTIVE: It was observed that glomerular hyperfiltration (GHF) is associated with progression of kidney disease in diabetics, patients in stage 1 hypertension (HT), and we found previously that eGFR decreased faster also in prehypertensives (PHT) with GHF. Here we analyzed whether GHF in PHT is associated with other biomarkers of early renal impairment. DESIGN AND METHOD: From 954 subjects enrolled in ENAH follow-up study, 371(137 m;mean age = 46years) were eligible for further analysis:100 with optimal,72 with normal BP,70 with PHT(high normal BP),and 129 with newly diagnosed untreated HT...
September 2016: Journal of Hypertension
Chi Chiu Mok
Renal disease in systemic lupus erythematosus (SLE) carries significant morbidity and mortality. Cyclophosphamide (CYC)- and mycophenolate mofetil (MMF)-based induction regimens are not ideal in terms of efficacy and toxicity. The adverse effects of CYC, such as infection risk, infertility, urotoxicity and oncogenicity, limit its use in lupus nephritis. Although MMF is non-inferior to CYC as induction therapy and has reduced gonadal toxicity and oncogenic potential, meta-analyses of clinical trials do not show a lower rate of infective and gastrointestinal complications...
October 2016: Nephrology, Dialysis, Transplantation
Jin Han, Ya Gao, Qi Guo, Dan Su, Bin Yan, Liyuan Peng, Yuxing Du, Ke Li, Gang Wang
OBJECTIVE: To investigate the relationship between the level of serum cystatin C (s-CC) and reverse-dipper blood pressure (BP) pattern. DESIGN: Cross-sectional study. SETTING: Single centre. PARTICIPANTS: A total of 718 hypertensive patients were eventually recruited from cardiac clinics between 2012 and 2014 in the Second Affiliated Hospital, Xi'an Jiaotong University. They were diagnosed as essential hypertension according to their casual office records of systolic blood pressure (SBP) and/or diastolic blood pressure (DBP)...
2016: BMJ Open
Youxia Liu, Xinxin Ma, Jie Zheng, Xiangchun Liu, Tiekun Yan
BACKGROUND: The outcomes of pregnancy in immunoglobulin A nephropathy (IgAN) remain controversial. We sought to evaluate the effect of pregnancy on the progression of IgAN as well as the impact of IgAN on pregnancy outcomes. METHODS: We systematically searched MEDLINE, Embase for cohort or case-control studies. OR reductions were calculated with a random-effects model, and kidney outcomes and adverse pregnancy events were analyzed. RESULTS: Our literature search returned 652 relevant articles; 4 studies were included, providing data of 376 pregnancies in 273 patients with IgAN and that of 241 IgAN who did not become pregnant...
2016: American Journal of Nephrology
Juhi Bharti, Richa Vatsa, Seema Singhal, Kallol Kumar Roy, Sunesh Kumar, Vanamail Perumal, Jyoti Meena
OBJECTIVE: Pregnancy with chronic kidney disease (CKD) is considered to be high risk. The purpose of this study was to assess the effect of pregnancy on CKD and the fetomaternal outcome in these patients. STUDY DESIGN: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of medical sciences, New Delhi over a period of 11 years. A total number of 80 pregnant patients with CKD were reviewed. Staging of CKD was done according to glomerular filtration rate (GFR)...
September 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
A Vrdoljak, V Ivkovic, S Karanovic, Z Dika, V Domislovic, K Dapic, L Gallineo, E Ivandic, J Josipovic, I Vukovic, J Kos, M Laganovic, T Zeljkovic Vrkic, M Fistrek Prlic, I Pecin, M Fucek, J Sertic, N Leko, B Jelakovic
OBJECTIVE: Chronic kidney disease(CKD) is established CV risk factor, and already early renal impairment(RI) increases risk for hypertension(HT) and loss of renal function. It was reported that blood pressure (BP) and metabolic derangements are associated with glomerular hyperfiltration(GHF), and GHF increases risk of developing microalbuminuria (MA) in HT stage 1. Our aim was to analyze whether GHF predicts progression to HT and RI in apparently healthy subjects. DESIGN AND METHOD: Out of 954 subjects enrolled in ENAH follow-up study, 371 (137 m, 234 w; mean age = 46 years) were eligible for further analysis:100 with optimal, 72 with normal BP, 70 with PHT (high normal BP), and 129 with newly diagnosed untreated HT...
September 2016: Journal of Hypertension
Takuji Komeda, Shingo Ishii, Yumiko Itoh, Masaki Sanekata, Takayoshi Yoshikawa, Jingoro Shimada
Peramivir, the only injectable anti-influenza neuraminidase inhibitor medically available in Japan at present, is considered first-line treatment in patients with high risk factors for influenza exacerbation. We conducted a drug-use investigation of peramivir in inpatients with high risk factors (old age, pregnancy, and underlying disease such as chronic respiratory disease) from January 2010 to March 2013. Data of 772 patients from 124 facilities across Japan were collected; peramivir's safety in 770 patients and effectiveness in 688 patients were examined...
October 2016: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Alyssa Fitzpatrick, Fadak Mohammadi, Shilpanjali Jesudason
Parenthood is a central focus for women with chronic kidney disease, but raises important fears and uncertainties about risks to their own and their baby's health. Pregnancy in women with background kidney disease, women receiving dialysis, or those with a functioning kidney transplant poses a challenging clinical scenario, associated with high maternal-fetal morbidity and potential impact on maternal renal health. Improvements in care over recent decades have led to a paradigm shift with cautious optimism and growing interest regarding pregnancies in women with chronic kidney disease...
2016: International Journal of Women's Health
Claire Mounier-Vehier, Anne-Laure Madika, Fanny Boudghène-Stambouli, Guillaume Ledieu, Pascal Delsart, Vassilis Tsatsaris
Preeclampsia is a specific risk factor chronic of hypertension, of coronary events (Ray et al., 2005), of stroke (Brown et al., 2006), of chronic renal failure (Kattah and Garovic, 2005; McDonald et al., 2003; Williams, 2003) and a specific risk factor of cardio-cerebrovascular mortality (Magnussen et al., 2009). According to Magnusson et al. (2009), the relative long-term risk of developing hypertension is multiplied by 4; the risk of diabetes and metabolic syndrome multiplied by 3; the risk of coronary heart disease and stroke multiplied by 2...
July 2016: La Presse Médicale
Denis Fouque, Jing Chen, Wei Chen, Liliana Garneata, S J Hwang, Kamyar Kalantar-Zadeh, Joel D Kopple, William E Mitch, Giorgina Piccoli, Vladimir Teplan, Philippe Chauveau
BACKGROUND: Low protein diets (LPD) have long been prescribed to chronic kidney disease patients with the goals of improving metabolic abnormalities and postpone the start of maintenance dialysis. METHODS: We reviewed the recent literature addressing low protein diets supplemented with ketoacids/essential aminoacids prescribed during chronic kidney disease and their effects on metabolic, nutritional and renal parameters since 2013. RESULTS: We show new information on how to improve adherence to these diets, on metabolic improvement and delay of the dialysis needs, and preliminary data in chronic kidney disease associated pregnancy...
July 7, 2016: BMC Nephrology
Chelsie Warshafsky, Jessica Pudwell, Mark Walker, Shi-Wu Wen, Graeme N Smith
OBJECTIVE: To prospectively examine whether children of women with a pregnancy affected by severe pre-eclampsia (PE), compared to children of women without a PE-affected pregnancy, have differences in neurodevelopmental performance up to 5 years of age. DESIGN: Prospective cohort study. SETTING: Tertiary care centre. PARTICIPANTS: Women were recruited following a PE-affected pregnancy. After each PE participant was recruited, the next normotensive woman without a prior history of PE and matched by parity, maternal age and race was invited to participate...
2016: BMJ Open
Matthew Hall
In women with chronic kidney disease (CKD), pregnancy outcomes have improved over the last 50 years, particularly in the developed world. Maternal mortality is now extremely low, fetal survival has markedly increased (even in women with CKD stages 4-5), and it is now the exception for women with CKD to be advised against embarking on a pregnancy. However, pregnancies are rarely free from complications, and there are unanswered questions about the longer term effects on maternal and infant health. The developments have led to a more optimistic attitude to pregnancy in women with CKD not requiring renal replacement treatment...
October 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Abdel Polanco-Nasser
Pregnancy is a physiological process that brings many changes to the mother's body, undergoing a process of adaptation to complications avoid, however, in the context of chronic kidney disease, these become manifest most frequently maternal and fetal impact on morbidity and mortality. A review of the subject is presented, emphasizing aspects that must be present at the time of a patient with this condition, accompanied by one of our cases treated with the sole purpose of gaining a better understanding of the issue and how to address it based on problems at the time of evaluation initial...
December 2015: Ginecología y Obstetricia de México
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