What is biparietal diameter/kidney length ratio in cases with renal hyperechogenicity?

The object of this study was to investigate the fetal biparietal diameter/kidney length ratio in normal and hyperechogenic kidneys during the 3rd trimester of gestation. Screened pregnancies were chronically hypoxic [i.e. intrauterine growth retardation (IUGR)]. Depending on the renal manifestation of the intrauterine chronic hypoxia, the cases were divided into two study groups. Group I was composed of 28 fetuses with IUGR and hyperechogenic renal medullae. Group II consisted of 62 fetuses with IUGR and normal echoic kidney. Both study groups included pregnant women from the 3rd trimester. Fetal renal hyperechogenicity is an indicator of depression of fetal renal perfusion, correlated with pathological growth in the fetal kidney development. The fetal biparietal diameter/kidney length ratio was significantly higher in hyperechogenic cases. This may also be an in utero indicator of subsequent intrauterine and neonatal complications. Detailed ultrasound examinations of renal parenchyma and length appear to be useful in the prenatal diagnosis of reduced renal perfusion and of intrauterine hypoxia, allowing detection of possible pathological fetal conditions in utero.     

Fetal renal hyperechogenicity in intrauterine growth retardation: importance and outcome

The object of the study was to investigate the outcome in growth-retarded newborns who were diagnosed with fetal renal hyperechogenicity without anatomical abnormality during any stage of pregnancy. Depending on the fetal renal ultrasonography result, the cases were divided into two study groups. There was an intrauterine growth-retarded group with fetal renal medullary hyperechogenicity and another group without fetal renal medullary hyperechogenicity. The renal parenchyma was observed after birth, within the first 5 days of life, and several times until the 14thpostpartum day in positive cases. Hyperechogenic renal medullae were detected in 25 of 90 cases with intrauterine growth retardation during the 8-month study period. This may be an in utero cause of subsequent intrauterine and neonatal complications, such as cesarean section because of fetal distress (36%), perinatal infection (24%), treatment in a neonatal intensive care unit (52%), or increased perinatal mortality (8%). The results demonstrate that fetuses with hyperechoic medullae had 1.5 times the risk of an abnormal outcome compared with fetuses with normal echoic kidneys and intrauterine growth retardation. Detailed ultrasound examinations of renal parenchyma appear to be useful for the prenatal diagnosis of intrauterine hypoxia, allowing the detection of possible pathological fetal conditions in utero. Received: 2 November 1999 / Revised: 1 February 2001 / Accepted: 7 February 2001     

Pregnancy and renal transplantation

Ovarian dysfunction, anovulatory vaginal bleeding, amenorrhea, high prolactin levels, and loss of libido are the causes of infertility in women with chronic renal failure. After renal transplantation, endocrine function generally improves after recovery of renal function. In this study we retrospectively evaluated the prepregnancy and postdelivery renal function, outcome of gestation, as well as maternal and fetal complications for eight pregnancies in eight renal transplant recipients between November 1975 and March 2003 of 1095 among 1425. Eight planned pregnancies occurred at a mean of 3.6 years posttransplant. Spontaneous abortion occured in the first trimester in one case. One intrauterine growth retardation was observed with a full-term pregnancy; one intrauterine growth retardation and preterm delivery; one preeclampsia with preterm delivery and urinary tract infection; and one preeclampsia with preterm delivery and oligohydramnios. The mean gestation period was 35.5 +/- 3.0 weeks (31.2 to 38.0). Pregnancy had no negative impact on renal function during a 2-year follow-up. No significant proteinuria or acute rejection episodes were observed. Among the seven deliveries, no congenital anomaly was documented and no postpartum problems for the child and the mother were observed. Our study suggests that successful pregnancy is possible in renal transplant recipients. In cases with good graft function and absence of severe proteinuria or hypertension, pregnancy does not affect graft function or patient survival; however, fetal problems are encountered such as intrauterine growth retardation, low birth weight, and preeclampsia.     

妊娠相关肾损伤对妊娠结局的影响

目的：探讨妊娠相关肾损伤对妊娠结局的影响。方法：采用回顾性分析方法调查2004年9月～2007年8月期间住院患者的妊娠肾损伤对妊娠结局的影响。结果：75例妊娠患者存在肾损伤,占2.58%。妊娠相关肾损伤的产科并发症（包括早产,胎儿宫内窘迫）的发病率升高,总的新生儿存活率90%。经单因素分析高血压、中重度妊娠高血压综合征的发生、蛋白尿、大量蛋白尿和低蛋白血症可能导致不良妊娠结果相关（P〈0.05）。结论：在Scr〈123μmol/L的患者中,妊娠并发症相对较少,孕妇大多成功分娩,妊娠结果相对较理想。在Scr≥124μmol/L的患者中,随着肾功能的恶化,妊娠并发症明显升高,产科并发症也相对增高。     

Pregnancy in women with chronic renal disease: a 14-year study.

Between 1975 and 1988 authors encountered 44 pregnancies in 26 women who had had chronic renal disease and unimpaired renal function before the conception. Complications during pregnancy and the outcome of pregnancy were studied. There were 5 spontaneous abortions between the 11th and 20th weeks of gestation, 1 therapeutic abortion, 3 still births at weeks 28, 32 and 33, 6 neonatal deaths at age of 26 to 35 weeks, 11 preterm newborns, 35 live births, 9 infants with intrauterine growth retardation including 4 preterm newborns and 1 fetal malformation and 2 cases with premature rupture of the fetal membranes. The pregnancies were complicated with anaemia in 23 cases, with urinary tract infection in 19, with hypertension in 16, with proteinuria in 12 and with edema in 11 cases. Increase in the serum creatinine value during pregnancy was found in 6 cases. These data indicate that the pregnancy in patients with chronic renal disease who had normal renal function before the planned conception, is accompanied with increased risk for both the mother and child.     

Clinical features and influence factors of pregnancy-induced hypertension with renal impairment at high altitude

Objective To investigate the incidence and clinical features of women with hypertension disorders of pregnancy complicated with renal impairment at high altitude, and explore the impact of proteinuria, renal insufficiency and preexisting chronic kidney disease (CKD) on these patients. Methods A pool of 1790 pregnant women admitted to Yunnan Diqing Tibetan Autonomous Prefecture People's Hospital from September 2017 to September 2018. Data of 123 patients who met the criteria of hypertension disorders in pregnancy were collected and retrospectively studied. Their clinical characteristics and pregnancy outcomes were analyzed. Patients with hypertension and renal impairment, simple hypertension patients as well as normal pregnant women were compared. Hypertensive patients with proteinuria, renal insufficiency (Scr＞70 μmol/L) and preexisting CKD were also compared with simple hypertension patients. The impact of proteinuria, renal insufficiency and preexisting CKD on patients with hypertension disorders of pregnancy was assessed by multivariate logistic analysis. Results Of these 123 patients, 61 cases (49.6%) had renal impairment, 57 cases (46.3%) had proteinuria, 15 cases (12.2%) had renal insufficiency and 6 cases (4.9%) had preexisting CKD. Compared with normal pregnant women and simple hypertension patients, patients with hypertension and renal impairment had higher blood pressure, Scr, primipara rate and caesarean section rate (all P＜0.05), lower gestational age, neonatal Apgar scores and plasma albumin level (all P＜0.05), as well as adverse pregnancy outcomes, including premature birth, stillbirth/neonatal death, intrauterine growth restriction, infants of low-birth weight and admission to the neonatal intensive care unit (NICU) (all P＜0.05). The clinical features and pregnancy outcomes of 57 patients with proteinuria correlated with the proteinuria. Compared with non-nephrotic syndrome patients and patients without proteinuria, patients with nephrotic syndrome (NS) had lower plasma albumin level and higher rates of premature birth, infants of low-birth weight and admission to NICU (all P＜0.05). Among 15 patients with renal insufficiency, there were 13 mild abnormal cases (70 μmol/L＜Scr≤123 μmol/L, 86.7%). Compared with those with normal renal function, patients with renal insufficiency had higher Scr, uric acid and rates of preeclampsia/eclampsia, intrauterine growth restriction, infants of low-birth weight and admission to NICU, while lower plasma albumin level (all P＜0.05). Among 6 patients with preexisting CKD, 4 had NS, 2 had renal insufficiency, 5 delivered before 37 weeks, and 2 infants died. Logistic regression analysis showed that NS (OR=4.863, P=0.032), renal insufficiency (OR=7.550, P=0.017) and systolic pressure (OR=1.061, P=0.002) were independent risk factors for adverse pregnancy outcomes among patients with hypertension disorders in pregnancy. Conclusions Renal impairment is common among patients with hypertension disorders in pregnancy at high altitude and has adverse effects on pregnancy outcomes. Massive proteinuria, renal insufficiency and systolic pressure are risk factors for these patients.     

Pregnancy after renal transplantation: A single-center experience

Objectives:   To examine women with renal transplants who became pregnant, and delivered at our hospital.
Methods:   Twenty-six women who had undergone renal transplantation between 1977 and 2002 became pregnant, and delivered at Osaka University Hospital. Complete medical records of twenty of them were retrieved and retrospectively analyzed.
Results:   Overall, twenty-nine pregnancies occurred in these twenty women after renal transplantation. There were spontaneous abortions in three cases, whereas pregnancy was artificially terminated five times. Thus, neonates were delivered in 21 of 29 pregnancies. One woman delivered twice and two women delivered twins. As a result, a total of 23 neonates were delivered. Mean gestational period was 35.4 weeks (range, 27–41 weeks), and mean birth weight was 2229 g (range, 724–3544 g). Regarding fetal complications, intrauterine growth retardation was observed in three cases. One child with intrauterine growth retardation died at 3 months old due to respiratory distress syndrome. One child displayed double-outlet right ventricle and another child had congenital unilateral hydronephrosis. Regarding maternal complications, prevalence of toxemia of pregnancy was 38.1%. In four of the 21 deliveries (19.0%), renal function exacerbated after delivery. Rates of graft survival for the 20 women at 1, 5 and 10 years after delivery were 100%, 85.1% and 74.4%, respectively. Prognosis for renal transplant resulted to be significantly poorer for recipients with hypertension before pregnancy than for recipients without hypertension before pregnancy (log-rank test, P  = 0.043).
Conclusions:   Rates of graft survival after delivery were mostly favorable. However, prognosis for renal function was poorer for recipients who displayed hypertension prior to pregnancy.     

Pregnancy in renal transplant patients: a review.

A questionnaire survey and review of the literature show that pregnancy can be well tolerated in most women with renal transplants. Fifty-two per cent of the renal transplant recipients who became pregnant had full-term infants with no serious complications. With therapeutic abortions, excluded, 71% of the 308 pregnancies permitted to continue resulted in full-term infants. Rejection episodes were occasionally a serious problem, occurring in 9% of the pregnancies. Mechanical interference with renal excretion or preventing vaginal delivery occurred in 5.6% of the cases. Hypertension and proteinuria, often existing prior to pregnancy, became frequently increased during pregnancy. Infections not associated with rejection were common but easily controlled in most cases. Prematurity was frequent but related to renal function and the time interval from transplant to conception. The most serious infant complications were related to prematurity. Unknown is the future of these infants and their progeny because of their intrauterine exposure to immunosuppressive drugs.     

Membranous glomerulonephritis and pregnancy

The clinical courses of 33 pregnancies in 24 patients with biopsy proven membranous glomerulonephritis have been analyzed. Twenty-four percent (8) of pregnancies resulted in fetal loss, 43% (14) in premature delivery and 33% (11) in a live birth after 36 weeks gestation. Maternal renal function declined during pregnancy in 9% (3) of the pregnancies and in 46% (15) hypertension developed. In 55% (18) proteinuria increased significantly during pregnancy. In 30% (10) nephrotic range proteinuria was recorded in the first trimester. Presence of nephrotic range proteinuria during the first trimester correlated with both poor fetal and poor maternal outcome (p less than 0.0004 and p less than 0.0002, respectively). It is concluded that pregnancy in patients with membranous glomerulonephritis is associated with increased fetal loss and, in some instances, a worsening in maternal renal function. The literature on this topic is reviewed in relation to these findings.     

Maternal hemodynamics and pregnancy outcome in women with prior orthotopic liver transplantation

The aim of this study is to evaluate the hemodynamics and pregnancy outcome of women with prior orthotopic liver transplantation. Hemodynamic measurements by Doppler technique were performed on pregnant subjects with prior orthotopic liver transplantation. Maternal characteristics, renal function, pregnancy complications, delivery indications, delivery mode, and neonatal outcomes were evaluated. Six pregnancies occurred in 5 women after orthotopic liver transplantation at the University of Washington Medical Center (Seattle, WA) between 1991 and 1999. Four of the 6 pregnancies were complicated by chronic hypertension, fetal growth restriction, and preterm delivery. Two pregnancies had worsening hypertension characterized by vasoconstriction in the second trimester despite antihypertensive therapy. These 2 subjects were administered cyclosporine for maintenance immunosuppression and had greater mean arterial pressures preconception and in the first trimester than the other subjects. One of these pregnancies resulted in fetal demise at 25 weeks' gestation. The other subject was delivered at 28 weeks' gestation for nonreassuring fetal status and superimposed preeclampsia. All pregnancies were complicated by renal insufficiency; however, the 2 subjects with poor obstetric outcome had preconception serum creatinine levels greater than 1.5 mg/dL and creatinine clearances less than 40 mL/min. Pregnancies complicated by second-trimester vasoconstriction and moderate renal insufficiency are at risk for preeclamspia, fetal growth restriction, and fetal demise. Good obstetric outcome can occur in women with mild renal insufficiency and well-controlled chronic hypertension. Improved hypertensive control preconception may decrease the risk for preeclampsia and poor obstetric outcome.     

Can Intrauterine Death of a Co-Twin Result in Renal Failure in the Survivor?

Multiple pregnancies are characterized by significantly higher rates of intrauterine and perinatal morbidities and fetal death compared to singleton pregnancies. It is well known that the death of a co-twin during the second and third trimester can cause damage in the other fetus. Here we report two newborn cases presenting with renal failure probably caused by intrauterine death of their co-twins shortly before birth.     

内镜逆行胰胆管造影术治疗妊娠合并急性胆管炎

目的探讨内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗妊娠合并急性胆管炎的效果及安全性.方法对本院2001年8月至2009年2月采用ERCP联合乳头切开术(endoscopic sphincterotomy,EST)治疗的16例妊娠合并急性胆管炎患者的临床资料进行回顾性分析.结果2例于妊娠3个月(妊娠早期)时行ERCP术+塑料内支架引流,未行EST取石,分别于术后4个月和5个月后内支架堵塞,再次行EST术取石.8例妊娠中期病例,7例一次性EST取净结石;1例因胆总管有多枚结石,行EST部分取石后放置塑料内支架,分娩后2周再行ERCP术取净结石.6例妊娠末3个月患者,5例1次行EST术取石成功;1例造影见胆总管结石多枚,直接放置塑料内支架1根引流,分娩1个月后,再行ERCP术取净结石.1例妊娠末3个月患者术后并发急性轻型胰腺炎,经治疗后痊愈;其余病例无术后并发症发生.全部病例随访至胎儿出生后1个月,未发现早产和宫内胎儿窘迫病例,无畸形、发育迟缓、智力低下儿出生.结论短期随访显示,ERCP治疗妊娠合并急性胆管炎安全有效.但目前尚缺乏射线对胎儿是否有影响的长期随访结果.     

Renal transplantation and pregnancy

Renal transplantation is usually accompanied by an improvement in reproductive function. The possibility of conception in women of childbearing age emphasizes the need for counseling, and couples who want a child should be encouraged to discuss all implications, with the advice based on strict guidelines. If a recipient becomes pregnant, she must be monitored as a high-risk patient. Management requires particular attention to BP control, renal function, and all infection, as well as fetal surveillance. Just under 40% of conceptions do not go beyond the first trimester, but of those that do, greater than 90% end successfully. In most patients, renal hemodynamics improve during gestation, but permanent impairment occurs in 15% of pregnancies. Other patients may experience transient deterioration in late pregnancy (with or without proteinuria). Patients have a 30% chance of developing hypertension, preeclampsia, or both. Despite its pelvic location, the transplanted kidney rarely produces dystocia and experiences no apparent mechanical injury during vaginal delivery. Thus, cesarean section should be reserved for obstetric reasons only. Aseptic technique, bacterial prophylaxis even for trivial surgery, and steroid augmentation are necessary. Preterm deliveries occur in 45% to 60%, and intrauterine growth retardation in at least 20%, of gestations. Neonatal complications include respiratory distress syndrome, leukopenia, thrombocytopenia, adrenocortical insufficiency, and infection. No predominant or frequent developmental abnormalities have been described, and data on infancy and childhood are encouraging. Future goals should be to improve prepregnancy assessment criteria, to reassess the rationale and implications of immunosuppression during pregnancy, and to monitor the remote effects of pregnancy on both renal prognosis and the offspring.     

Influences of pregnancy on the natural course of chronic glomerulonephritis with impaired renal function]

In an attempt to clarify the influence of pregnancy on the natural course of the chronic glomerulonephritis with impaired renal function (glomerular filtration rate: GFR less than or equal to 70 ml/min), the courses of 14 pregnancies occurring in 10 patients (seven with IgA nephropathy, one with membranoproliferative glomerulonephritis, one with membranous nephropathy and one with hereditary nephropathy) were studied. In 8 patients GFR measured before pregnancies ranged from 46 to 70 ml/min and in the other two creatinine clearance estimated in the first trimester of pregnancies was 62 and 49 ml/min, respectively. The pregnancies resulted in 10 live births, one spontaneous abortion, one artificial abortion and 2 neonatal deaths. In 2 out of 10 live births fetal weight was less than 2500 g. In 3 of 11 pregnancies there was neither increase in urinary protein nor elevation of blood pressure during pregnancies, while seven (64%) had increased proteinuria during the third trimester, and 4 of them were also complicated with hypertension. In 6 of 10 patients, there was no decrease in GFR during pregnancies. In three patients GFR was decreased from 70 to 36 ml/min, 70 to 58 ml/min and 62 to 48 ml/min, respectively. However, these reductions were considered to go with the natural course of respective patients because the reduction slopes were almost the same or rather mild in comparison with those estimated before or after pregnancies. The other patient also had a transient increase in serum creatinine level during two pregnancies, but the reciprocals of serum creatinine concentration before and after the pregnanciesdeclined linearly with time. These data suggest that pregnancy might have little influence on the natural course of the chronic glomerulonephritis even if complicated with renal functional impairment defined as GFR of 70 ml/min or less.     

Immediate and long-term renal effects of fetal exposure to gentamicin

Aminoglycoside antibiotics, like gentamicin, given to pregnant females cross the placenta and accumulate in the fetal kidney, which, like the adult kidney, was found to be the major site of deposition. In young guineapigs whose mothers were given gentamicin during the week following nephrogenesis in the fetus, nephron growth was found to be retarded temporarily. In rats whose mothers were given gentamicin during the period of fetal nephrogenesis, the final number of nephrons was reduced by about 20%. In both cases, renal development was imparied. although the concentration of gentamicin in the fetal kidney was lower than that measured in the kidney of human fetuses whose mothers had received a single injection of aminoglycoside. In rats exposed to gentamicin in utero, cellular damage of the undifferentiated and differentiating renal tissues was observed. It is, there are likely that the oligonephronia observed in animals born of gentamicin-treated mothers resulted from a direct effect of the drug at early stages of nephrogenesis. When gentamicin administration to the mother was prolonged, part of the oligonephronia observed at birth might have also resulted from fetal growth retardation, secondary to adverse effects of the drug on the mother. Providing it was not associated with fetal growth retardation, the presence of high gentamicin concentrations in the fetal kidney at late stages of nephrogenesis did not affect nephron differentiation. Long-term studies of rats born with gentamicin-induced oligone-phronia showed that neither the antibiotic still present in kidney several weeks after birth, nor the injuries it caused, prevented renal growth and morphological adaptation of the nephrons to their reduced number. This also holds true for functional adaptation, except in the case of phosphate transport. Of interest is the fact that the mild oligonephronia acquired in utero after exposure to gentamicin was sufficient to cause early development of glomerular sclerosis in the adults.     

Pregnancy outcome after renal transplantation

AIMS: The aim of our study was to evaluate the frequency and the outcome of pregnancies in renal transplant recipients at our center. METHODS: This study involved the retrospective analysis of 405 childbearing female renal recipients for presence of risk factors, the outcome of pregnancy, and maternal and fetal complications. RESULTS: Fourty-four pregnancies occurred in 41 patients (10.8%). Mean age at transplantation was 23.6 +/- 6.3 years (range, 12-38 years). Only in 5 pregnancies were there no risk factors. In 13 (29.5%) pregnancies, the previous creatinine level was >1.5 mg/dL, in 16 (36.45%), proteinuria was >500 mg/24 hours; 29 (65.9%) were hypertensive; 14 (31.8%) had a time between transplantation and pregnancy less than 2 years (mean time, 35.5 +/- 30.9 months; range, 3-120 months). The outcomes were 27 (61.4%; 11 term and 16 premature delivery) successful pregnancies, 6 (13.6%) spontaneous abortions, 10 (22.7%) therapeutic abortions, and 1 (3.2%) fetal death. Pre-eclampsia occurred in 9 (20.4%) pregnancies and eclampsia in 1 (2.2%). The mean weight of the offspring was 2195 +/- 490 g (range, 1300- 2980 g). There were 2 cases of acute fetal distress and 1 oligodramnios. Median creatinine level was 1.0 (range, 0.4-3.0) mg/dL before conception and 1.2 (range, 0.7-9.0) mg/dL 6 month after pregnancy (P <.001). The long-term patient and graft survival rates were similar for pregnant versus nonpregnant recipients in the childbearing age. CONCLUSION: Most pregnancies were successful, although the premature delivery rate was high (36.4%). Only 5 conceptions occurred in the absence of risk factors. Pregnancy did not impair the patient and graft survival during long-term follow-up.     

妊娠期顽固性肾绞痛的腔内处理

目的探讨腔内诊治妊娠期肾积水合并顽固性肾绞痛的安全性和有效性。 方法回顾性分析2017年3月至2018年9月我院收治的78例妊娠期肾积水合并顽固性肾绞痛患者的病例资料。根据顽固性肾绞痛持续时间将患者分为A组（6 h以内16例）,B组（6～12 h 53例）和C组（12 h以上9例）。 结果58例术中发现输尿管结石,16例（27.6%）术前彩超未见输尿管结石,行输尿管镜碎石取石和留置输尿管双J管。输尿管结石清除率87.9%（51/58）。20例未发现输尿管结石但合并肾盂结石患者,术中留置输尿管双J管。9例（11.5%）有先兆流产表现,其中A组1例（6.25%）,B组4例（7.55%）,C组4例（44.4%）。C组先兆流产的发生率高于A和B组（P<0.05）。1例（6.25%）患者出现尿源性脓毒血症,抗感染等对症处理后痊愈。所有患者均成功通过围产期并生产健康婴儿。 结论对于妊娠期肾积水合并顽固性肾绞痛的患者,早期输尿管镜腔内处理是有效安全的诊断和治疗手段,可降低孕妇和胎儿的风险。     

Dialysis, transplantation, and pregnancy

Women on regular dialysis are usually infertile, but contraception should not be neglected. Pregnancy is invariably complicated and poses excessive risks, with an uncertain and low chance of success. Even when therapeutic abortion is excluded, the live birth outcome at best is 19%. Renal transplantation usually reverses abnormal reproductive function and comprehensive pre-pregnancy counseling is essential, with discussion of all implications, including the harsh realities of long-term maternal survival. In this survey of 2,309 pregnancies in 1,594 women, therapeutic abortion was undertaken in 27% of conceptions and the spontaneous abortion rate was 13%. Of the conceptions that continued beyond the first trimester, 92% ended successfully. In most, renal function was augmented in pregnancy, with transient deterioration in late pregnancy (with or without proteinuria). Permanent renal impairment occurred in 15% of pregnancies. There was a 30% chance of developing hypertension, preeclampsia or both. Preterm delivery occurred in 50%, and intrauterine growth retardation in 25% of pregnancies. Despite its pelvic location, the transplanted kidney rarely produced dystocia and was not injured during vaginal delivery. Cesarean section should be reserved for obstetric reasons only. Neonatal complications include respiratory distress syndrome, leukopenia, thrombocytopenia, adrenocortical insufficiency, and infection. No predominant or frequent developmental abnormalities have been described and data on infancy and childhood are encouraging. For the future more work is needed to improve pre-pregnancy assessment criteria, to understand the mechanisms of gestational renal dysfunction and proteinuria, to assess the side effects and implications of immunosuppression in pregnancy, and to elucidate the remote effects of pregnancy on both renal prognosis and the offspring.     

Acute renal failure requiring haemodialysis in obstetrics

Acute renal failure (ARF) requiring hemodialysis is a rare complication of pregnancy in western world, but in developing countries, it is still frequent. The objective of this study was to determine the epidemiology, etiologies, clinical data and outcomes for pregnant women with ARF requiring dialysis. We studied the records of 58 patients with ARF who had needed dialysis in the obstetric intensive care unit of the maternity teaching hospital of Ibn Rochd (Casablanca) between January 1st 2002 and 31st December 2008. Anterior renal diseases and post-renal causes were excluded. Epidemiological, clinical, biological data were recorded, the outcome of patients were studied 1 and 3 months after discharge from hospital. The incidence of ARF in our unit was 9.87 per 10,000 pregnancies; and constitutes 2.49% of all admissions in the obstetric ICU. The mean age and parity were respectively 28±7 years and 2.82. Main aetiology was preeclampsia-eclampsia (39 cases: 67.2%), haemorrhage (15 cases: 25.9%), sepsis (five cases: 8.6%), fetal death, (two cases: 3.6%) and acute fatty liver (one patient: 1.8%). Often, several causes were associated. In one case, we found no evident cause despite radiological imaging and histological exam. Recovery is faster in pre-eclampsia than others causes. The outcomes included renal recovery in 42 cases (72.4%), chronic renal failure in four cases (6.9%). Mortality rate was 13.8% (eight deaths). Preventive and early management of obstetrical complications could improve pregnancy-associated ARF.     

In utero exposure to immunosuppressive drugs: experimental and clinical studies

Over the last few decades, the number of pregnant women under immunosuppressive (IS) therapy following transplantation or autoimmune diseases has increased. At first, IS drugs, including prednisone, azathioprine, and cyclosporine A were used, but now new molecules such as tacrolimus and mycophenolate mofetil have appeared. These IS drugs cross the placental barrier and enter into the fetal circulation, which poses a risk for fetal development. Experimental data have shown that IS drugs often have deleterious effects on fetuses, while human data have reported an increased rate of abortion, prematurity, intrauterine growth retardation (IUGR), and low birth weight, without significant increases in malformation rates. However, only limited information is available about the newly used molecules. Although fetal and neonatal data are reassuring, long-term effects of IS drugs on fertility, immune response and renal function, as well as the consequences of prematurity and IUGR, should be monitored. Received: 29 May 2001 / Revised: 3 October 2001 / Accepted: 9 October 2001