by expert on call (297 Posts), Tue Jul 15, 2003 09:17 pm
There is a literature regarding pregnancy in women with reflux nephropathy that her nephrologist may be aware (reviewed for example the normal and diseased kidney in pregnancy chapter in the 2001 (7th) edition of RW SchrierÃ¢â‚¬â„¢s text, Diseases of the Kidney, NY Lippincott, Williams, & Wilkens. Also she should not be afraid to specifically ask her nephrologist for advice.. For instance there are very large series from France (JungerÃ¢â‚¬â„¢s group in Paris) and Australia (Kincaid-SmithÃ¢â‚¬â„¢s group in Melbourne). It appears that in the absence of hypertension and with preserved renal function pregnancy or only mild functional loss that over 95% of the gestations succeed and there is little or no evidence of that pregnancy has a deleterious course on the natural history of the renal disease. With hypertension and moderate dysfunction there is a risk of renal deterioration and a marked increase in superimposed preeclampsia as well as loss of control of the preexisting hypertension, values rising to levels considered severe.
Since this patient already has hypertension (that carries a 20-25% incidence of superimposed preeclampsia) and has what sounds like moderate renal functional loss her risks are substantial. If her blood pressure has not been treated adequately in the past and can now be controlled more effectively and her serum creatinine levels are below 1.5 mg/dl (possible if her glomerular filtration by creatinine clearance is really 64 ml/min,(renography not being that adequate to measure clearances) some would consider monitoring a pregnancy in such a patient at a tertiary center under the care of a nephrologists and fetal-maternal-medicine subspecialist, (these physicians, obviously being a bit more optimistic than the advice above).
Again the patient should reconsult her nephrologists with specific questions. The nephrologists should be familiar with the literature mentioned above (or can seek one of us for further advice).
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