Pregnancy in renal transplant patients: Renal function markers and maternal-fetal outcomes

Author(s)

Sato Tebet, Jussara Leiko ^[1] ; Kirsztajn, Gianna Mastroianni ^[2] ; Facca, Thais Alquezar ^[1] ; Nishida, Sonia K. ^[3] ; Pereira, Amelia Rodrigues ^[3] ; Moreira, Silvia Regina ^[3] ; Pestana Medina, Jose Osmar ^[2] ; Sass, Nelson ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Med Sch, Obstet Dept, Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo, Div Nephrol, Sao Paulo - Brazil

^[3] Univ Fed Sao Paulo, Dept Biomed Sci, Div Nephrol, Sao Paulo - Brazil

• Document type: Journal article
• Source: PREGNANCY HYPERTENSION-AN INTERNATIONAL JOURNAL OF WOMENS CARDIOVASCULAR HEALTH; v. 15, p. 108-113, JAN 2019.
• Web of Science Citations: 1

Abstract

Objectives: We aimed to evaluate laboratory markers in women who got pregnant after renal transplantation. Study design: Cross-sectional prospective study. Main outcome measures: Renal function parameters and maternal and fetal data were assessed in renal transplant recipients. Results: Forty-three women who got pregnant after renal transplantation (mean age, 28.5 years; mean gestational age, 35.6 weeks) were included. Most patients (53.5%) received a renal transplant from a deceased donor. Podocyturia was not significantly correlated with other renal function markers. Mean period from transplantation to pregnancy was approximately 5 years; this period was not associated with obstetric complications or changes in renal markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P < 0.001), proteinuria (P < 0.001), urinary protein/creatinine ratio (P < 0.001), and albumin/creatinine ratio (P < 0.001). The sensitivity and specificity of protein/creatinine ratio in predicting preeclampsia were high (96.0% and 94.0%, respectively). Elevated serum creatinine levels, urinary albumin/creatinine ratio, and retinol-binding protein levels in the third trimester were associated with prematurity (P < 0.001). Preeclampsia was the main cause of renal function decline at the end of pregnancy (65.0% of cases). Approximately four (9.5%) pregnant women presented with premature rupture of membranes and 18 (42.0%) with a urinary tract infection. Conclusions: Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Using these markers to assess renal function during pregnancy may be clinically useful for detecting and monitoring renal injury in renal transplant recipients. (AU)

• FAPESP's process: 14/00213-7 - Preeclampsia: future risk of chronic kidney disease and cardiovascular injury
• Grantee: Nelson Sass
• Support Opportunities: Regular Research Grants