Chronic glomerulonephritis and pregnancy

• Main Authors: V A Rogov, E M Shilov, N L Kozlovskaya, N В Gordovskaya, O V Nikiforova, I O Makarov, A P Milovanov
• Format: Article
• Language: Russian
• Published: "Consilium Medicum" Publishing house 2004-09-01
• Series: Терапевтический архив
• Subjects: chronic glomerulonephritis; pregnancy; placental insufficiency; functional renal reserve; blood flow in uterine arteries; fetal loss; preterm delivery
• Online Access: https://ter-arkhiv.ru/0040-3660/article/view/29880

Aim. To clarify factors of risk for unfavourable variants of gestational chronic glomerulonephritis (CGN) and poor pregnancy outcomes in CGN; to determine prognostic implications of changes in some renal and uteroplacental indices. Material and methods. Variants of CGN gestational course and pregnancy outcomes have been analysed for 156 CGN patients. The women were examined before pregnancy, in the course of pregnancy and 3-24 months after the delivery. Measurements were made of 24 h proteinuria, glomerular filtration rate, blood transaminases activity, functional renal reserve (FRR), uricemia, blood level ofalphaphetoprotein. Placentas were studied morphologically, uterine and umbilical artery circulation was assessed by dopplerometry. Results. The following abnormalities were registered: high proteinuria (34.6%), progression of hypertension (29.5%), renal function deterioration (15.4%), fetal and neonatal losses (15.4%), fetal underdevelopment (25%), preterm delivery (17.3%), preeclampsia (7.7%), preterm placental detachment (1.9%). There is morphological, dopplerometric and biochemical evidence for placental insufficiency in CGN pregnant women. Conclusion. Activity of CGN (nephritic or acute nephritic syndromes), hypertension, renal failure, disorders of renal hemodynamics are factors of risk for unfavourable gestational course of CGN and pregnancy complications. Placental insufficiency deteriorates pregnancy outcomes in CGN, but changes in uterine and umbilical circulation as well as blood levels of alpha-fetoprotein are not prognostically significant.