THE EFFECT OF PREGNANCY ON KIDNEY-FUNCTION IN RENAL-ALLOGRAFT RECIPIENTS
THE EFFECT OF PREGNANCY ON KIDNEY-FUNCTION IN RENAL-ALLOGRAFT RECIPIENTS
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DOI：
10.1038/ki.1985.12
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发表时间：
1985-01-01
影响因子：
19.6
通讯作者：
DAVISON, JM
中科院分区：
文献类型：
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作者：
DAVISON, JM
在肾移植的女性中，肾小球滤过率（GFR）在妊娠期间增加，但增加发生的时间，其与妊娠前GFR的关系以及总体变化模式尚不清楚。前瞻性地测量了8例同种异体移植受者的10次妊娠的24小时肌酐清除率（24 h CCr），包括妊娠前、妊娠期间、产后8-12周和4-6个月。然后还测定了输注期间菊粉（CIn）和肌酐（CCr）的清除率，并评价了蛋白排泄。结果与10名健康女性的类似研究进行了比较。到妊娠第10周，24小时CCr为124 ± 1.24。(SD)健康妇女为15.9 ml/min（增加38%：范围18-69%），移植患者为105 ± 100 ml/min。28.1 ml/min（增加34%：范围，10-60%），在受孕前同种异体移植物功能最好的患者中增加最大，无论供体来源和性别或移植妊娠间隔如何。在妊娠晚期，健康女性的平均24 h CCr下降了19%（范围，6-28%），移植患者下降了34%（范围，12-57%），但在大多数情况下，这并不代表移植物恶化，也不导致永久性损伤。在所有时间点，CIn值比24 h CCr值高5-10%，但略低于输注CCr值。在整个妊娠期和妊娠晚期，健康女性的蛋白质排泄量增加，平均24小时内200 mg，移植患者24小时内经常超过500 mg，这是非妊娠水平的3倍，可能没有临床意义。关于妊娠对长期肾脏预后的影响没有明确的模式，但在10例妊娠中，有8例在产后8-12周时GFR恢复到妊娠前值。可以得出结论，肾移植适应妊娠正常，并减少GFR和蛋白尿在第三个三个月是常见的，但通常是短暂的。需要进一步的研究来回答妊娠对肾脏预后的影响。
In women with renal transplants glomerular filtration rate (GFR) increases during pregnancy but how soon the increment occurs, its relation to pre-pregnancy GFR, and the overall pattern of change is unknown. Twenty-four hour creatinine clearances (24 h CCr) were measured prospectively in 10 pregnancies in 8 allograft recipients before conception, throughout pregnancy, 8-12 wk postpartum, and 4-6 mo. thereafter. Inulin (CIn) and creatinine (CCr) clearances during infusion were also determined and protein excretion was evaluated. The results were compared to those in similar studies in 10 healthy women. By the 10th gestational wk 24 h CCr was 124 .+-. (SD) 15.9 ml/min in healthy women (an increase of 38%: range, 18-69%) and in transplant patients was 105 .+-. 28.1 ml/min (an increase of 34%: range, 10-60%), with the greatest increments in those whose allografts functioned best before conception, regardless of donor source and sex or the transplant-pregnancy interval. In late pregnancy mean 24 h CCr decreased by 19% (range, 6-28%) in healthy women and by 34% (range, 12-57%) in the transplant patients, but in most this did not represent graft deterioration nor lead to permanent impairment. At all time points CIn values were 5-10% greater than those for 24h CCr but slightly less than infusion CCr values. Protein excretion increased throughout pregnancy and by the 3rd trimester in healthy women averaged 200 mg in 24 h and regularly exceeded 500 mg in 24 h in transplant patients, which was 3 times nonpregnant levels and probably not clinically significant. No definite pattern was evident regarding the effect of pregnancy on longterm renal prognosis but in 8 of the 10 pregnancies GFR had returned to pre-pregnancy values by 8-12 wk postpartum. It can be concluded that renal allografts adapt to pregnancy normally and that reduced GFR and proteinuria in the 3rd trimester are common but usually transient. Further studies are needed to answer questions on the effects of pregnancy on renal prognosis.