Pregnancy in Chronic Kidney Disease
Pregnancy in Chronic Kidney Disease
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DOI：
10.1053/j.ackd.2013.02.001
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发表时间：
2013-05-01
影响因子：
2.9
通讯作者：
Vellanki, Kavitha
中科院分区：
文献类型：
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作者：
Vellanki, Kavitha
尽管胎儿结局有了巨大的改善，但CKD女性的妊娠充满了危险;肾功能恶化和先兆子痫和早产等并发症很常见。迄今为止，没有精确的公式来计算肾小球滤过率（GFR）。此外，目前的CKD分类在预测CKD孕妇的结局方面是否优于旧分类尚不清楚。估计GFR >= 1.4 mg/dL的女性肾功能进行性恶化的风险增加，无论潜在肾脏疾病的原因如何。先兆子痫是很难诊断的孕妇与潜在的CKD，血清标志物，如可溶性fms样酪氨酸激酶1（sFlt 1）和胎盘生长因子（PIGF）可能导致明确的诊断。新发狼疮或狼疮发作是妊娠期间肾活检的指征;环孢素是安全的，是妊娠期间可以使用的最有效的药物。患有成人多囊肾病的妇女在怀孕期间患高血压和先兆子痫的风险增加，以及在以后的生活中患肝囊肿的风险增加，后者发生在多胎妊娠中。糖尿病肾病的治疗方法有哪些？应由处理高危妊娠的肾脏科医生和产科医生组成的多学科团队参与患有慢性肾病的孕妇的护理，以获得成功的妊娠结局。(c)2013年，美国国家肾脏基金会（National Kidney Foundation，Inc.）All rights reserved.
Despite vast improvements in fetal outcomes, pregnancy in women with CKD is fraught with hazards; worsening of renal function and complications like preeclampsia and premature delivery are common. To date, there is no accurate formula to calculate glomerular filtration rate (GFR). Also, whether the current CKD classification is better than the older classification at predicting outcomes in pregnant women with CKD is unknown. Women with an estimated GFR >= 1.4 mg/dL are at increased risk of progressive worsening of renal function regardless of the cause of the underlying kidney disease. Preeclampsia is difficult to diagnose in pregnant women with underlying CKD, and serum markers such as soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PIGF) may lead the way for definitive diagnosis. New-onset lupus or lupus flare is an indication for kidney biopsy during pregnancy; cyclosporine is safe and is the most effective agent that can be used during pregnancy. Women with adult polycystic kidney disease are at increased risk of hypertension and preeclampsia during pregnancy, as well as hepatic cysts later in life, the latter occurring with multiple pregnancies. Strict blood pressure control is important in pregnant women with diabetic nephropathy. A multidisciplinary team that includes nephrologists and obstetricians who deal with high-risk pregnancies should be involved in the care of pregnant women with CKD for successful pregnancy outcomes. (c) 2013 by the National Kidney Foundation, Inc. All rights reserved.