Sfida e cura: il ruolo cruciale del nefrologo nella gestione della gravidanza per le donne affette dalla malattia del rene policistico autosomico dominante dell’adulto
DOI:
https://doi.org/10.33393/gcnd.2023.2628Keywords:
Autosomal dominant polycystic kidney disease, ADPKP, PregnancyAbstract
The optimal outcome in a healthy pregnancy is when the infant is born at full term with minimal adverse physical effects on the mother. So, it may not be news to a nephrologist that the maternal kidneys play such a crucial role in this process, but it is a point worth underscoring when a woman with kidney disease contemplates pregnancy.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease. Its primary characteristics are gradual enlargement of both kidneys and progressive loss of renal function. The emerging ability to halt disease progression in its early stages emphasizes the importance of accurate and timely ADPKD diagnosis.
It is well known that pregnancy represents an overall risk factor of adverse maternal and fetal outcomes in chronic kidney disease (CKD) regardless of the nephropathy.
For women with ADPKD pregnancy is often a top concern certainly because of the risk of worsening their renal condition, but also of passing the disease on to their offspring,
The effects of pregnancy on renal disease in ADPKD are still not clear.
The purpose of this work is to review the literature on pregnancy and ADPKD and reconsider the role of the nephrologist in actively supporting women before and during pregnancy.
Pregnancy in ADPKD has been associated with poor fetal outcomes and an increased risk of maternal renal failure in early studies. However, there are only few non-exhaustive works on non-stratified patients by degree of renal failure and abdominal size; recent reports seem more encouraging showing better outcomes because of improved pregnancy surveillance and adequate prior counseling.
Certainly, advanced maternal age, preexisting hypertension, urinary infections, proteinuria and renal failure remain important risk factors for poor fetal and maternal outcomes, just as in any advanced chronic nephropathy. On the other hand, pregnancy outcomes in normotensive women with ADPKD and normal renal function result in a favorable outcome.
Regarding to the disease's inheritance preimplantation genetic testing and contemporary assisted reproductive methods have decreased the risk from 50% to 1-2%.
Finally, women with ADPKD planning pregnancy should be aware about the risk related to pre-existing hypertension, poor control of it, recurrent infections and kidney failure, but also that a closely monitored and tailored pregnancy can have a favorable outcome.
Therefore, collaboration between nephrologists and gynecologists is essential, with the intention of bringing together some of the crucial, clinically significant concerns that nephrologists involved in the treatment of pregnant women need to be aware of.
As members of a multidisciplinary team, we strongly believe that nephrologists should play an active role in assisting and supporting pregnant ADPKD patients.
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Accepted 2023-07-03
Published 2023-09-30
