Serious long-term adverse outcomes are a risk for women identiied to have nephrotic syndromes either before or during pregnancy (Su, 2017). In our series above, at least 20 percent of women followed for 10 years progressed to end-stage renal disease (Stettler, 1992). Similarly, in another group of 15 women, by 2 years postpartum, three had died, three had developed chronic renal failure, and two had progressed to end-stage renal disease (Chen, 2001). Of predictors, serum creatinine levela> 1.4 mg/ dL and 24-hour protein excretiona> 1 g/d are associated with the shortest renal survival times following pregnancy (Imbasciati, 2007).
his describes a pathophysiological process that can progress to end-stage renal disease. he National Kidney Foundation describes six stages of chronic kidney disease defined by decreasing GFR. It progresses from stage O-GFR >90 mLi min/1.73 mato stage 5-GFR < 15 mLimin/1.73 ma. Several diseases can worsen renal function, and many result from one of the glomerular diseases discussed earlier. hose that most frequently lead to end-stage disease requiring dialysis and kidney transplantation and their approximate percentages include: diabetes, 35 percent; hypertension, 25 percent; glomerulonephritis, 20 percent; and polycystic kidney disease, 15 percent (Abboud, 2010; Bargman, 2015).
reproductive-aged women with these diseases have varying degrees of renal insuiciency, proteinuria, or both. To counsel regarding fertility and pregnancy outcome, the degree of renal functional impairment and of associated hypertension are assessed. Successful pregnancy outcome in general may be more related to these two factors than to the speciic underlying renal disorder. A general prognosis can be estimated by considering women with chronic renal disease in arbitrary categories of renal function (Davison, 2011). hese include normal or mild impairment--deined as a serum creatinine < 1.5 mg/ dL; moderate impairment-deined as a serum creatinine 1.5 to 3.0 mg/dL; and severe renal insuiciencydeined as a serum creatinine >3.0 mg/dL. Although some have suggested adopting the classification of the National Kidney Foundation, others recommend using the older categories (Davison, 2011a; Piccoli, 201 Oa, 2011). Thus, the obstetrician is ideally familiar with both.
Most women have relatively mild renal insuiciency, and its severity along with any underlying hypertension is prognostic of pregnancy outcome. Renal disease with comorbidities secondary to a systemic disorder-for example, diabetes or systemic lupus erythematosus-portends a worse prognosis (Davison, 2011; Koh, 2015). For all women with chronic renal disease, the incidences of hypertension and preeclampsia, preterm and growthrestricted newborns, and other problems are high (Kendrick, 2015). Despite these, the National High Blood Pressure Education Program (2000) concluded that the prognosis has substantively improved since the 1980s. his has been verified by several reviews (Hladunewich, 2016a; Nevis, 2011; Ramin, 2006).
Loss of renal tissue is associated with compensatory intrarenal vasodilation and hypertrophy of the surviving nephrons. he resultant hyperperfusion and hyperiltration eventually damage surviving nephrons to cause nephrosclerosis and worsening renal function. With mild renal insuiciency, pregnancy causes 0.
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