Skip to main content
Erschienen in: Kidney 1/2008

01.02.2008

Pregnancy in Patients with Diabetic Nephropathy

verfasst von: Saeed Abdelwhab Saeed, Hamed Ellakwa

Erschienen in: Kidney | Ausgabe 1/2008

Einloggen, um Zugang zu erhalten

Abstract

Background and Aim

To determine the influence of pregnancy on renal functions in patients with diabetic nephropathy and influence of diabetic nephropathy on pregnancy outcome.

Methods

A prospective cohort study was carried out on 15 patients with diabetic nephropathy with pregnancy (group 1), 15 diabetic patients with diabetic nephropathy without pregnancy (group 2) and 15 pregnant diabetic patients without nephropathy (group 3). Patients with diabetic nephropathy with serum creatinine less than 3 mg% were involved. Renal function tests were done every 3 months for 18 months. Pregnancy outcome and complications were recorded.

Results

Comparing group 1 and group 2 shows significant difference as regards percent increase in serum creatinine, percent change in GFR and percent increase in urinary proteins. Comparing group 1 and group 3 shows significant difference as regards rate of toxemia of pregnancy, preterm delivery and small for age babies. Mean blood pressure, GFR deterioration and mean HbA1c are the main determinant of most complications.

Conclusions

Pregnancy leads to deterioration in renal functions in patients with diabetic nephropathy with elevated serum creatinine; also the presence of diabetic nephropathy increases pregnancy unfavorable outcomes. Special care should be given to blood pressure control, blood sugar control and control of renal condition.
Literatur
1.
Zurück zum Zitat Alaveras AEG, Thomas SM, Sagriotis A, Viberti G. Promoters of progression of diabetic nephropathy: the relative roles of blood glucose and blood pressure control. Nephrol Dial Transplant 1997;12:71–4.PubMedCrossRef Alaveras AEG, Thomas SM, Sagriotis A, Viberti G. Promoters of progression of diabetic nephropathy: the relative roles of blood glucose and blood pressure control. Nephrol Dial Transplant 1997;12:71–4.PubMedCrossRef
2.
Zurück zum Zitat Amini SB, Catalano PM, Hirsch V, Mann LI. An analysis of birth weight by gestational age using a computerized perinatal data base1975–1992. Obstet Gynecol. 1994;83:342–52.PubMed Amini SB, Catalano PM, Hirsch V, Mann LI. An analysis of birth weight by gestational age using a computerized perinatal data base1975–1992. Obstet Gynecol. 1994;83:342–52.PubMed
3.
Zurück zum Zitat Ananth CV, Joseph KS, Yenka O. Trends in preterm birth and perinatal mortality. Obstet Gynecol. 2005;105:1084–91.PubMed Ananth CV, Joseph KS, Yenka O. Trends in preterm birth and perinatal mortality. Obstet Gynecol. 2005;105:1084–91.PubMed
4.
Zurück zum Zitat Bojestig M, Arnqvist HJ, Hermansson G, Karlberg BE, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med. 1994;330:15–8.PubMedCrossRef Bojestig M, Arnqvist HJ, Hermansson G, Karlberg BE, Ludvigsson J. Declining incidence of nephropathy in insulin-dependent diabetes mellitus. N Engl J Med. 1994;330:15–8.PubMedCrossRef
5.
Zurück zum Zitat Carr DB, Koontz GL, Gardella C, Holing EV, Brateng DA, Brown Z. Diabetic nephropathy in pregnancy: suboptimal hypertensive control associated with preterm delivery. Am J Hypertens. 2006;19:513–9.PubMedCrossRef Carr DB, Koontz GL, Gardella C, Holing EV, Brateng DA, Brown Z. Diabetic nephropathy in pregnancy: suboptimal hypertensive control associated with preterm delivery. Am J Hypertens. 2006;19:513–9.PubMedCrossRef
6.
Zurück zum Zitat Combs CA, Rosenn B, Kitzmiller JL. Early-pregnancy proteinuria in diabetes related to preeclampsia. Obstet Gynecol 1993;82:802–7.PubMed Combs CA, Rosenn B, Kitzmiller JL. Early-pregnancy proteinuria in diabetes related to preeclampsia. Obstet Gynecol 1993;82:802–7.PubMed
7.
Zurück zum Zitat Connell FA, Vadheim C, Emanuel I. Diabetes in pregnancy: a population-based study of incidence, referral for care and perinatal mortality. Am J Obstet Gynecol. 1985;151:598–603.PubMed Connell FA, Vadheim C, Emanuel I. Diabetes in pregnancy: a population-based study of incidence, referral for care and perinatal mortality. Am J Obstet Gynecol. 1985;151:598–603.PubMed
8.
Zurück zum Zitat Cunningham FG, Cox SM, Harstad TW, Mason RA, Pritchard JA. Chronic renal disease and pregnancy outcome. Am J Obstet Gynecol. 1990;163:453–9.PubMed Cunningham FG, Cox SM, Harstad TW, Mason RA, Pritchard JA. Chronic renal disease and pregnancy outcome. Am J Obstet Gynecol. 1990;163:453–9.PubMed
9.
Zurück zum Zitat David C, John P. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996;335:226–32.CrossRef David C, John P. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med. 1996;335:226–32.CrossRef
10.
Zurück zum Zitat Dunne FP, Chowdhury TA, Hartland A, Smith T, Brydon PA, McConkey C, et al. Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. Q J Med. 1999;92:451–4. Dunne FP, Chowdhury TA, Hartland A, Smith T, Brydon PA, McConkey C, et al. Pregnancy outcome in women with insulin-dependent diabetes mellitus complicated by nephropathy. Q J Med. 1999;92:451–4.
11.
Zurück zum Zitat Biesenbach G, Stöger H, Zazgornik J. Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function. Nephrol Dial Transplant. 1992;7:105–9.PubMed Biesenbach G, Stöger H, Zazgornik J. Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function. Nephrol Dial Transplant. 1992;7:105–9.PubMed
12.
Zurück zum Zitat Biesenbach G, Grafinger P, Stoger H, Zarzgornik J. How pregnancy influences renal function in nephropathic type 1 diabetic women depends on their pre-conceptional creatinine clearance. J Nephrol. 1999;12:41–6.PubMed Biesenbach G, Grafinger P, Stoger H, Zarzgornik J. How pregnancy influences renal function in nephropathic type 1 diabetic women depends on their pre-conceptional creatinine clearance. J Nephrol. 1999;12:41–6.PubMed
13.
Zurück zum Zitat Giorgina B, Elisabetta M, Giorgio G, Manuel B, Tullia T. A 35-year-old woman with diabetic nephropathy who wants a baby: case progression. BMJ. 2004;329:729. Giorgina B, Elisabetta M, Giorgio G, Manuel B, Tullia T. A 35-year-old woman with diabetic nephropathy who wants a baby: case progression. BMJ. 2004;329:729.
14.
Zurück zum Zitat Giovanni FM, Maria C, Francesco P, Jonathan C. Role of blood pressure targets and specific antihypertensive agents used to prevent diabetic nephropathy and delay its progression. J Am Soc Nephrol. 2006;17:153–5.CrossRef Giovanni FM, Maria C, Francesco P, Jonathan C. Role of blood pressure targets and specific antihypertensive agents used to prevent diabetic nephropathy and delay its progression. J Am Soc Nephrol. 2006;17:153–5.CrossRef
15.
Zurück zum Zitat Irfan S, Arain TM, Shaukat A, Shahid A. Effect of pregnancy on diabetic nephropathy and retinopathy. J Coll Physicians Surg Pak. 2004;14:63–4. Irfan S, Arain TM, Shaukat A, Shahid A. Effect of pregnancy on diabetic nephropathy and retinopathy. J Coll Physicians Surg Pak. 2004;14:63–4.
16.
Zurück zum Zitat Israelit AH, Long DL, White MG, Hull AR. Measurement of glomerular filtration rate utilizing a single subcutaneous injection of [125I]iothalamate. Kidney Int. 1973;4:346–9.PubMedCrossRef Israelit AH, Long DL, White MG, Hull AR. Measurement of glomerular filtration rate utilizing a single subcutaneous injection of [125I]iothalamate. Kidney Int. 1973;4:346–9.PubMedCrossRef
17.
Zurück zum Zitat Khoury JC, Miodovnik M, LeMasters G, Sibai B. Pregnancy outcome and progression of diabetic nephropathy. What’s next. J Matern Fetal Neonatal Med. 2002;11:238–44.PubMedCrossRef Khoury JC, Miodovnik M, LeMasters G, Sibai B. Pregnancy outcome and progression of diabetic nephropathy. What’s next. J Matern Fetal Neonatal Med. 2002;11:238–44.PubMedCrossRef
18.
Zurück zum Zitat Knochel JP, Breyer JA, Cronin RE, Falk RJ, Gabow P, Hayslett J. Medical knowledge self-assessment program in the subspecialty of nephrology and hypertension. Philadelphia: American College of Physicians 1994;143. Knochel JP, Breyer JA, Cronin RE, Falk RJ, Gabow P, Hayslett J. Medical knowledge self-assessment program in the subspecialty of nephrology and hypertension. Philadelphia: American College of Physicians 1994;143.
19.
Zurück zum Zitat Leguizamon G, Reece EA. Effect of medical therapy on progressive nephropathy: influence of pregnancy, diabetes and hypertension. J Matern Fetal Med. 2000;9:70–8.PubMedCrossRef Leguizamon G, Reece EA. Effect of medical therapy on progressive nephropathy: influence of pregnancy, diabetes and hypertension. J Matern Fetal Med. 2000;9:70–8.PubMedCrossRef
20.
Zurück zum Zitat Lindheimer MD, Katz AI. In: Seldin DW, Giebisch G, editors. Renal physiology and disease in pregnancy. New York: Raven; 1992. Lindheimer MD, Katz AI. In: Seldin DW, Giebisch G, editors. Renal physiology and disease in pregnancy. New York: Raven; 1992.
21.
Zurück zum Zitat Maura R, Michela R, Luca D, Simone V, Giacomo D. Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol. 2006;17:98–103.CrossRef Maura R, Michela R, Luca D, Simone V, Giacomo D. Importance of blood pressure control in chronic kidney disease. J Am Soc Nephrol. 2006;17:98–103.CrossRef
22.
Zurück zum Zitat Miodovnik M, Rosenn BM, Khoury JC, Grigsby JL, Siddiqi TA. Does pregnancy increase the risk for development and progression of diabetic nephropathy. Am J Obstet Gynecol.1996;174:1180–9.PubMedCrossRef Miodovnik M, Rosenn BM, Khoury JC, Grigsby JL, Siddiqi TA. Does pregnancy increase the risk for development and progression of diabetic nephropathy. Am J Obstet Gynecol.1996;174:1180–9.PubMedCrossRef
23.
Zurück zum Zitat Packham DK, North RA, Fairley KF, Kloss M, Whitworth JA, Kincaid-Smith P. Primary glomerulonephritis and pregnancy. Q J Med. 1989;266:537–53. Packham DK, North RA, Fairley KF, Kloss M, Whitworth JA, Kincaid-Smith P. Primary glomerulonephritis and pregnancy. Q J Med. 1989;266:537–53.
24.
Zurück zum Zitat Pia E, Peter D, Bo F, Ulla F, Jens M, Elisabeth R. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24:1739–44.CrossRef Pia E, Peter D, Bo F, Ulla F, Jens M, Elisabeth R. Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care. 2001;24:1739–44.CrossRef
25.
Zurück zum Zitat Purdy P, Hantsch CM, Christina E, Mark E, Boyd E, Richard L, et al. Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care. 1996;19:1067–74.PubMedCrossRef Purdy P, Hantsch CM, Christina E, Mark E, Boyd E, Richard L, et al. Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care. 1996;19:1067–74.PubMedCrossRef
26.
Zurück zum Zitat Quadri KH, Bernardini J, Greenberg A, Laifer S, Syed A, Holley JL. Assessment of renal function during pregnancy using a random urine protein to creatinine ratio and Cockcroft–Gault formula. Am J Kidney Dis. 1994;24:416–20.PubMed Quadri KH, Bernardini J, Greenberg A, Laifer S, Syed A, Holley JL. Assessment of renal function during pregnancy using a random urine protein to creatinine ratio and Cockcroft–Gault formula. Am J Kidney Dis. 1994;24:416–20.PubMed
27.
Zurück zum Zitat Reece AE, Leguizaman G, Homko C. Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes. J Matern-Fetal Med. 1998;7:213–6.PubMedCrossRef Reece AE, Leguizaman G, Homko C. Stringent controls in diabetic nephropathy associated with optimization of pregnancy outcomes. J Matern-Fetal Med. 1998;7:213–6.PubMedCrossRef
28.
Zurück zum Zitat Reece EA, Leguizamon G, Homko C. Pregnancy performance and outcomes associated with diabetic nephropathy. Am J Perinatol. 1998;15:413–21.PubMedCrossRef Reece EA, Leguizamon G, Homko C. Pregnancy performance and outcomes associated with diabetic nephropathy. Am J Perinatol. 1998;15:413–21.PubMedCrossRef
29.
Zurück zum Zitat Ritz E. Diabetic nephropathy. Saudi J Kidney Dis Transpl. 2006;17:481–90.PubMed Ritz E. Diabetic nephropathy. Saudi J Kidney Dis Transpl. 2006;17:481–90.PubMed
30.
Zurück zum Zitat Rossing K, Jacobsen P, Hommel E, Mathiesen E, Svenningsen A, Rossing P, et al. Pregnancy and progression of diabetic nephropathy. Diabetologia. 2002;45:36–41.PubMedCrossRef Rossing K, Jacobsen P, Hommel E, Mathiesen E, Svenningsen A, Rossing P, et al. Pregnancy and progression of diabetic nephropathy. Diabetologia. 2002;45:36–41.PubMedCrossRef
31.
Zurück zum Zitat Savithiri R, Gideon K. Taking ACE inhibitors during pregnancy is it safe. Can Fam Physician. 2002;48:1047–9. Savithiri R, Gideon K. Taking ACE inhibitors during pregnancy is it safe. Can Fam Physician. 2002;48:1047–9.
32.
Zurück zum Zitat Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten PJ, MacPherson C, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol. 2000;182:364–9.PubMedCrossRef Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten PJ, MacPherson C, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol. 2000;182:364–9.PubMedCrossRef
33.
Zurück zum Zitat Tkacheva ON, Vertkin AL, Barabashkina AV, Vasil’eva AV, Razguliaeva NF. Effects on the cardiovascular system and the kidneys in pregnant and puerperal women with hypertension. Ter Arkh. 2006;78:56–61.PubMed Tkacheva ON, Vertkin AL, Barabashkina AV, Vasil’eva AV, Razguliaeva NF. Effects on the cardiovascular system and the kidneys in pregnant and puerperal women with hypertension. Ter Arkh. 2006;78:56–61.PubMed
Metadaten
Titel
Pregnancy in Patients with Diabetic Nephropathy
verfasst von
Saeed Abdelwhab Saeed
Hamed Ellakwa
Publikationsdatum
01.02.2008
Verlag
Springer-Verlag
Erschienen in
Kidney / Ausgabe 1/2008
Print ISSN: 0940-7936
Elektronische ISSN: 1865-5068
DOI
https://doi.org/10.1007/s00596-007-0001-6

Weitere Artikel der Ausgabe 1/2008

Kidney 1/2008 Zur Ausgabe

Nephrology in Brief

Nephrology in Brief

Literature Survey

D. Dialysis

Literature Survey

E. Transplantation

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Bei seelischem Stress sind Checkpoint-Hemmer weniger wirksam

03.06.2024 NSCLC Nachrichten

Wie stark Menschen mit fortgeschrittenem NSCLC von einer Therapie mit Immun-Checkpoint-Hemmern profitieren, hängt offenbar auch davon ab, wie sehr die Diagnose ihre psychische Verfassung erschüttert

Antikörper mobilisiert Neutrophile gegen Krebs

03.06.2024 Onkologische Immuntherapie Nachrichten

Ein bispezifischer Antikörper formiert gezielt eine Armee neutrophiler Granulozyten gegen Krebszellen. An den Antikörper gekoppeltes TNF-alpha soll die Zellen zudem tief in solide Tumoren hineinführen.

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

29.05.2024 Larynxkarzinom Nachrichten

Fast ein Viertel der Personen mit mäßig dysplastischen Stimmlippenläsionen entwickelt einen Kehlkopftumor. Solche Personen benötigen daher eine besonders enge ärztliche Überwachung.

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.