妊娠合并肾脏疾病的围生期处理策略

<正>肾脏是人体主要的排泄器官,肾脏的功能不仅控制整个身体水分,也决定代谢产物的保存、排泄与水电解质平衡。妊娠与肾脏疾病相互影响,肾脏疾病不利于妊娠,妊娠同样加剧肾脏负担。妊娠合并肾脏疾病并不多见,目前对其发病率尚无确切定论[1]。但妊娠合并肾脏疾病的种类较多,其病因、病理机制、临床表现多样性,为产科高危妊娠中的重要疾病。本文主要讨论妊娠合并肾脏疾病的围生期处理策略。1妊娠合并泌尿道感染     

妊娠合并肾脏疾病28例的产科处理

目的探讨妊娠合并肾脏疾病的产科处理。方法对妊娠合并肾脏疾病28例病例的产科处理做回顾性分析。结果28例妊娠合并肾脏疾病中合并肾炎的发病率最高(20/28),妊娠并发症中妊娠期高血压疾病发生率最高(10/28)。24例肾功能代偿期孕妇均定期接受产科检查,除1例孕13周时行人工流产术外,其余23例均足月正常分娩,母儿预后良好;3例合并妊娠期高血压疾病子痫前期(重度)、肾功能不全(氮质血症期),除1例早产外,另2例剖宫产终止妊娠,母儿预后良好;另有1例孕期未进行产前检查,孕24周合并妊娠期高血压疾病子痫前期(重度),胎儿宫内发育迟缓,肾功能不全(尿毒症期),以剖宫产终止妊娠,胎儿死亡。结论妊娠结局与妊娠合并肾脏疾病中肾功能的分期和有无妊娠并发症密切相关;孕期检查和适时、适当的产科处理对于围生儿、孕妇的预后至关重要。     

妊娠合并肾脏疾病孕妇早产的研究

妊娠合并肾脏疾病孕妇早产的研究杨丹，汤希伟在早产有关因素的研究中发现，妊娠合并肾脏疾病早产的发生率高，且位于其它内、外科疾病之首￣［１］。本研究对上海第二医科大学附属仁济医院妇产科，自１９８１年１１月至１９９３年３月间妊娠合并肾脏疾病６Ｃ例，以及同期...     

妊娠合并肾脏疾病的分类及诊治特点

<正>妊娠合并肾脏疾病大致可分为妊娠合并泌尿道感染、慢性肾小球肾炎、肾病综合征、多囊肾、尿石症、狼疮性肾炎、糖尿病肾病、肾移植和肾衰竭等。妊娠合并肾脏疾病患者的妊娠问题是临床常见的难题。产科和肾科医生共同参与患者的孕期管理,掌握不同肾脏疾病的诊治特点,其主要目的是减少妊娠对母体肾功能的损害和对胎儿结局的不良影响。     

肾脏疾病与妊娠的相互影响

<正>妊娠是母体一个特殊变化的时期,孕期合并症、并发症均可导致体内发生重要脏器的变化。肾脏具有调节排出代谢废物、控制体内电解质和酸碱平衡作用,同时还有内分泌功能,参与调节血压、红细胞生成和钙的代谢。在妊娠过程中,肾脏的结构和功能异常,间接或直接会对妊娠结局产生一定的影响。但正常妊娠和病理妊娠过程中肾脏的许多变化环节尚未阐明,妊娠对于基础肾脏疾病的影响程度以及与妊娠     

不宜妊娠的肾脏疾病

妊娠期由于肾血流量及肾小球滤过率增加，肾脏负担加重，并由于妊娠期的生理变化包括泌尿系的扩张，子宫增大后压迫输尿管，激素的变化，导致输尿管、肾盂扩张(主要在右侧)。某些肾脏疾病由于妊娠加重了病情，甚至进展到疾病的终末阶段。因此，妊娠前对已存在的肾脏疾患进行认真的评估，对决定能否妊娠是很重要的。以下讨论的是不宜妊娠的肾脏疾病。     

妊娠合并慢性肾病与不良妊娠结局

育龄期女性约3%合并慢性肾脏疾病,这些患者不良妊娠结局风险明显高于健康人群。基础肾脏功能、是否合并系统性疾病、慢性高血压以及蛋白尿均对妊娠结局有重要的影响。文章阐述合并慢性肾病患者不良妊娠结局发生情况,并简要介绍改善此类患者妊娠结局的措施。     

妊娠合并肾炎

肾脏疾病不利于妊娠,妊娠不利于肾脏疾病。妊娠期合并肾脏疾病重要的有肾盂肾炎、肾小球肾炎、妊高征所致肾脏病征和产科并发症所致肾功衰竭等。急性肾小球肾炎妊娠期罕发,其诊断与治疗较明确,预后较好。慢性肾小球肾炎(简称慢性肾炎)发病较多,其病因、病变、临床表现多样,尚缺乏特效治疗,为产科高危妊娠中的重要疾病,现仅就妊娠合并慢性肾炎的诊断和处理作简要介绍。慢性肾炎系由多种原发性肾小球疾病所致的一组长病程的以蛋白尿、血尿、水肿和高血压为主要临床表现的疾病。仅少数是由急性链球菌感染所致急性肾炎迁延而来,大多是其它原发性肾小球疾病对肾实质的免疫炎症过程持续进展的结果。其不同病理类型的改     

慢性肾脏疾病与子痫前期

近年来,妊娠女性合并慢性肾脏疾病患者的比例逐年增高,这些患者妊娠期间一旦并发子痫前期将严重影响母儿结局。文章将就孕前合并慢性肾脏疾病患者孕期子痫前期的风险、诊断和预防等方面内容进行介绍,以期指导临床,改善此类患者的临床预后。     

妊娠期的肾脏功能与肾脏疾病的研究进展

关于孕期的肾脏功能近年来是通过肾脏活检及廓清试验等对肾功能的连续观察才有了进一步的了解.临床上对原有肾脏疾病的患者能否耐受妊娠,及妊娠期常见泌尿系疾病的研究亦有不少进展.笔者仅就临床会诊     

Pregnancy in women with renal disease. Part II: specific underlying renal conditions

The obstetric outcome in women with kidney disease has improved in recent years due to continuous progress in obstetrics and neonatology, as well as better medical management of hypertension and renal disease. However, every pregnancy in these women remains a high-risk pregnancy. When considering the interaction between renal disease and pregnancy, maternal outcomes are related to the initial level of renal dysfunction more than to the specific underlying disease. With regards to fetal outcomes, though, a distinction may exist between renal dysfunction resulting from primary renal disease and that in which renal involvement is part of a systemic disease. In part II of this review, some specific causes of renal failure affecting pregnancy are considered.     

Renal disease in pregnancy

Renal disease in pregnancy may be progressive but only rarely. The problems encountered that create maternal and fetal morbidity and mortality relate to the development of superimposed preeclampsia and renal failure. Diagnosis is important to differentiate the cause of renal pathology so that appropriate treatment can be undertaken. The use of medications in renal disease in the presence of hypertension is controversial; however, adequate therapy should be given if indicated. Most cases of renal disease in pregnancy do not require termination; however, counseling concerning pregnancy is needed initially or subsequently.     

Pregnancy and sex hormone changes after kidney transplant

Sexual dysfunction is one of the common findings among chronic kidney disease (CKD) patients and can lead to a decline in sexual desire, fertility/potency, successful pregnancy, along with menorrhagia and occasionally, amenorrhoea. Successful kidney transplantation is an effective method to preserve sexual desire in both the sexes and to achieve successful pregnancy where reasonable planning can give favorable outcomes for both mother and embryo. This review summarizes some common reproductive alterations in men and women undergoing renal transplant.     

Enfermedad de Berger y gestación

IgA glomerulonephritis or Berger's disease is a kidney disease characterized by immunoglobulin A deposition in the mesangium of renal glomeruli. During pregnancy, key prognostic factors, such as blood pressure and renal function, should be monitored closely to avoid complications, both maternal and fetal. If these factors are regulated, pregnancy is entirely feasible.     

Sarcoidosis in pregnancy: a review with reference to kidney involvement

Sarcoidosis is a granulomatous multi-system disease of unknown aetiology affecting many organs. Generally, pregnancy has no adverse effect on sarcoidosis and it seems unlikely that the disease would affect the pregnancy or the fetus. Usually, a woman with sarcoidosis should be reassured to carry on her pregnancy. However, a progression of sarcoidosis and the outcome of pregnancy mostly depends on the type and severity of the extrapulmonary lesions. Some localisations, particularly in the kidney, although less often diagnosed may be life-threatening. Thus, a patient with advanced renal involvement should be followed carefully. We report a rare case of a pregnant woman with sarcoidosis giving rise to renal insufficiency due to nephrocalcinosis. The present case shows that the impairment of renal function prior to conception is of major importance. The use of colour Doppler sonography as an additional method for evaluation of kidney function is described.     

妊娠高血压综合征患者肾脏穿刺结果分析

目的：探讨妊娠高血压综合征(妊高征)患者行肾脏穿刺活检的安全性及了解肾脏病理改变与临床表现的关系。方法：对2000年8月至2002年2月13例妊高征患者于产后2周内(9例)及2周后(4例)采用16G弹射针B超引导下行肾脏穿刺活检，标本分别进行光镜、免疫荧光及部分行透射电镜检查。结果：妊高征肾脏的病理改变表现多样，其中表现为毛细血管内增生性肾小球肾炎3例，膜性肾病改变3例，肾小球轻微病变2例，系膜增生性肾小球肾炎2例，妊娠性肾病2例，局灶性硬化性肾小球肾炎1例。结论：妊高征患者肾脏穿刺活检是安全可行的，妊高征患者的肾脏病理改变可表现为各种病理类型，与临床病情无相关性，符合继发性肾病综合征改变。应对有肾脏损害的妊高征患者作相应随访，以发现妊娠诱发的肾脏疾病。     

Mechanisms behind flare of renal lupus during murine pregnancy

The outcome of pregnancy in systemic lupus erythematosus is still controversial. The authors recently reported the disappearance of the manifestation of the skin disease but a diminished survival rate in lupus-prone animals undergoing several pregnancies. It was postulated that lupus-prone animals must have subclinical renal symptoms at an early age and that immune and hormonal changes during pregnancy exacerbate immune reactions in the kidneys, leading to a shortened life span. Here, the authors analysed changes at day 14 of pregnancy in lupus-prone LPR (MRL/lpr) mice and MRL controls regarding cytokines, regulatory T (Treg) cells and deposition of immunocomplexes. Worsened kidney function was observed during pregnancy, even in the absence of lupus signs. This was accompanied by renal inflammation and higher interferon-gamma and interleukin-10 levels. C3 and immunoglobulin G deposition was enhanced in kidney and placenta from lupus-prone pregnant animals. Pregnancy enhanced the levels of Treg cells in control animals but not in lupus-prone animals. As pregnancy-induced Treg cells were shown to be specific for paternal antigens it is not to be expected that these Treg cells can help to destroy autoreactive cells. The authors conclude that early subclinical kidney disease in lupus-prone animals exacerbates during pregnancy. Albeit obtained with an experimental animal model, their data are potentially of importance for lupus patients of reproductive age.     

Renal disease in pregnancy

Women with kidney disease who become pregnant are at risk of further damage to their kidneys and an adverse pregnancy outcome. In general, women with mild renal dysfunction (Scr<125 μmol/litre) usually pass through pregnancy without adverse impact on their kidneys, although complications such as pre-eclampsia, fetal growth restriction and pre-term delivery are more likely. Women with severe renal impairment (Scr >220 mmol/litre) have a 1:3 risk of an accelerated decline in renal function because of pregnancy and pre-eclampsia, fetal growth restriction and pre-term delivery become common place. Clinical features such as pre-existing hypertension, proteinuria >1 g/24 hour and/or urinary tract infections add to the likelihood of complications. This article discusses important issues for women with kidney disease in pregnancy.