FP126MATERNAL, OBSTETRIC AND FETAL OUTCOMES IN CKD PREGNANT WOMAN - 7 YEARS EXPERIENCE OF A RENAL PREGNANCY CLINIC AT LISBON

Abstract

Introduction and Aims: Pregnancy in CKD patients is associated with adverse maternal, obstetric and fetal outcomes, with challenging complications emerging during gestation. Therefore a multidisciplinary team should be involved in their management, including a Nephrologist and an Obstetrician. Methods: Herein, the authors retrospectively analyzed the maternal (deterioration of renal function, new-onset or worsening of proteinuria and hypertension), obstetric (preeclampsia, caesarean delivery) and fetal outcomes (still birth, medical pregnancy interruption, prematurity, birth weight, need of neonatal intensive care) in the patients followed at the renal pregnancy clinic, in Hospital Santa Maria, Lisbon. Results: We evaluated 67 pregnancies in 63 patients from 2011-2017, with mean age 32 years (20-43 years), being 42 nulliparo us. Regarding renal function, mean Creatinine was 0,99mg/dl (0,2-4,6mg/dl), mean GFR 93ml/min (12-187ml/min), with 43/8/12/5/2 patients in CKD stage G1/G2/G3/G4/G5 respectively. During pregnancy, worsening renal function defined as increase creatinine >0,3mg/dl occurred in 12 patients (18%), 2/23 patients at CKD stage G1, 1/8 at stage G2, 5/12 at stage G3, 3/8 at stage G4,1/2 at stage G5. Partial or complete renal function recovery was observed in half of the patients 1/2,1/1,4/5, 3/3,1/1 patients at CKD stage G1,G2,G3,G4 and G5, respectively. Chronic Hypertension incidence was 48% (30/63 patients) in this popula-tion, with hypertension worsening occurring in 37% of the cases (11/30 patients). Prepregnancy proteinuria was present in 26/63 patients (41%) with mean proteinuria of 420mg/day (5-2000mg/day). Of those, 20/26 patients experienced proteinuria worsening (mean842mg/dayvs2839mg/day). New-onset proteinuria occurred in 11 patients due to preeclampsia (6 cases), HELLP syndrome (1 case), de novo glomerulopathy (3 cases), or related to worsening of CKD (1case). Regarding obstetric and fetal outcomes, 4 patients were submitted to medical pregnancy termination due to active lupus ou severe nephrotic syndrome. We found 3 still birth in 67 pregnancy. Preeclampsia and intrahepatic cholestasis emerged in 12(18%) and 1 patient respectively, with incidence of fetal growth restriction of 10% (7 patients). Mean gestational age was 37 weeks (26-41weeks), with 22% of pre-term delivery (< 37 weeks), and 9% of early pre-term delivery (<34 weeks). Cesarean delivery was needed in 24% of the patients (16/67 cases), and mean birth weight was 2760g (560-4600mg), with low birth weight (<2500g) of 22%.Neonatal intensive care admission occurred in 11 cases. Conclusions: Although pregnancy is generally successful in CKD patients, they must be aware of the potential impact in their kidney disease at long term. Early pre-pregnancy counseling must be engaged by physician to reduce adverse outcomes.