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Table of Contents
Vol. 34, No. 4, 2011
Issue release date: June 2011
Section title: Paper
Kidney Blood Press Res 2011;34:253–260
(DOI:10.1159/000327904)

Update on Pregnancy in Chronic Kidney Disease

Castellano G. · Losappio V. · Gesualdo L.
Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
email Corresponding Author

Abstract

The occurrence of pregnancy in patients with chronic kidney disease (CKD) has been considered a dangerous event both for the mother and for the fetus. However, increasing evidence shows that the stage of CKD is the leading factor that can predict possible acceleration in the declining of renal function and complications of pregnancy. This review summarizes recent data on pregnancy in patients with CKD, dialysis and kidney transplantation.

© 2011 S. Karger AG, Basel


  

Key Words

  • Pregnancy
  • Chronic kidney disease
  • Dialysis
  • Kidney transplantation

References

  1. Williams D, Davison J: Chronic kidney disease in pregnancy. BMJ 2008;336:211–215.
  2. Hou S: Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999;33:235–252.
  3. Baylis C: Glomerular filtration and volume regulation in gravid animal models. Baillieres Clin Obstet Gynaecol 1994;8:235–264.
  4. Maynard SE, Thadhani R: Pregnancy and the kidney. J Am Soc Nephrol 2009;20:14–22.
  5. Smith MC, Moran P, Ward MK, Davison JM: Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG 2008;115:109–112.
  6. Alper AB, Yi Y, Webber LS, Pridjian G, Mumuney AA, Saade G, Morgan J, Nuwayhid B, Belfort M, Puschett J: Estimation of glomerular filtration rate in preeclamptic patients. Am J Perinatol 2007;24:569–574.
  7. Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG: Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141:929–937.
  8. Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving HH, Steffes MW, Toto R: Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis 2003;42:617–622.
  9. Imbasciati E, Pardi G, Capetta P, Ambroso G, Bozzetti P, Pagliari B, Ponticelli C: Pregnancy in women with chronic renal failure. Am J Nephrol 1986;6:193–198.
  10. Purdy LP, Hantsch CE, Molitch ME, Metzger BE, Phelps RL, Dooley SL, Hou SH: Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care 1996;19:1067–1074.
  11. Jones DC, Hayslett JP: Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996;335:226–232.
  12. Sanders CL, Lucas MJ: Renal disease in pregnancy. Obstet Gynecol Clin North Am 2001;28:593–600, vii.
  13. Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P: Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis 2007;49:753–762.
  14. Piccoli GB, Attini R, Vasario E, Conijn A, Biolcati M, D’Amico F, Consiglio V, Bontempo S, Todros T: Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol 2010;5:844–855.
  15. McArdle A, Maduwegedera D, Moritz K, Flower RL, Denton KM, Roberts CT: Chronic maternal hypertension affects placental gene expression and differentiation in rabbits. J Hypertens 2010;28:959–968.
  16. McArdle AM, Roberts CT, Maduwegedera D, Flower RL, Denton KM: Chronic maternal hypertension characterized by renal dysfunction is associated with reduced placental blood flow during late gestation in rabbits. Am J Physiol Regul Integr Comp Physiol 2010;298:R1043–R1049.
  17. Laube GF, Kemper MJ, Schubiger G, Neuhaus TJ: Angiotensin-converting enzyme inhibitor fetopathy: long-term outcome. Arch Dis Child Fetal Neonatal Ed 2007;92:F402–F403.
  18. Alwan S, Polifka JE, Friedman JM: Angiotensin II receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol 2005;73:123–130.
  19. Baumwell S, Karumanchi SA: Pre-eclampsia: clinical manifestations and molecular mechanisms. Nephron Clin Pract 2007;106:c72–c81.
  20. Cornelis T, Odutayo A, Keunen J, Hladunewich M: The kidney in normal pregnancy and preeclampsia. Semin Nephrol 2011;31:4–14.
  21. Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA: Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003;111:649–658.
  22. Levine RJ, Lam C, Qian C, Yu KF, Maynard SE, Sachs BP, Sibai BM, Epstein FH, Romero R, Thadhani R, Karumanchi SA: Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med 2006;355:992–1005.
  23. Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA: Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004;350:672–683.
  24. Moore Simas TA, Crawford SL, Solitro MJ, Frost SC, Meyer BA, Maynard SE: Angiogenic factors for the prediction of preeclampsia in high-risk women. Am J Obstet Gynecol 2007;197:244–248.
  25. Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM: Preeclampsia and the risk of end-stage renal disease. N Engl J Med 2008;359:800–809.
  26. Gilbert JS, Verzwyvelt J, Colson D, Arany M, Karumanchi SA, Granger JP: Recombinant vascular endothelial growth factor 121 infusion lowers blood pressure and improves renal function in rats with placentalischemia-induced hypertension. Hypertension 2010;55:380–385.
  27. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA: Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007;369:1791–1798.
  28. Limardo M, Imbasciati E, Ravani P, Surian M, Torres D, Gregorini G, Magistroni R, Casellato D, Gammaro L, Pozzi C: Pregnancy and progression of IgA nephropathy: results of an Italian multicenter study. Am J Kidney Dis 2010;56:506–512.
  29. Goldstein AR, White RH, Akuse R, Chantler C: Long-term follow-up of childhood Henoch-Schönlein nephritis. Lancet 1992;339:280–282.
  30. Ronkainen J, Nuutinen M, Koskimies O: The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 2002;360:666–670.
  31. Kalmantis K, Daskalakis G, Iavazzo C, Vranos A, Mesogitis S, Antsaklis A: Henoch-Schönlein purpura in pregnancy. J Obstet Gynaecol 2008;28:403–405.
  32. Keeling SO, Oswald AE: Pregnancy and rheumatic disease: ‘by the book’ or ‘by the doc’. Clin Rheumatol 2009;28:1–9.
  33. Day CJ, Lipkin GW, Savage CO: Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 2009;24:344–347.
  34. Clowse ME: Lupus activity in pregnancy. Rheum Dis Clin North Am 2007;33:237–52, v.
  35. Clowse ME, Jamison M, Myers E, James AH: A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1–6.
  36. Wagner SJ, Craici I, Reed D, Norby S, Bailey K, Wiste HJ, Wood CM, Moder KG, Liang KP, Liang KV, Rose C, Rozkos T, Sitina M, Grande JP, Garovic VD: Maternal and foetal outcomes in pregnant patients with active lupus nephritis. Lupus 2009;18:342–347.
  37. Carmona F, Font J, Moga I, Lazaro I, Cervera R, Pac V, Balasch J: Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases. Am J Reprod Immunol 2005;53:182–188.
  38. Bolignano D, Coppolino G, Crasci E, Campo S, Aloisi C, Buemi M: Pregnancy in uremic patients: an eventful journey. J Obstet Gynaecol Res 2008;34:137–143.
  39. Vidaeff AC, Yeomans ER, Ramin SM: Pregnancy in women with renal disease. 1. General principles. Am J Perinatol 2008;25:385–397.
  40. Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S: Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis 1992;19:235–238.
  41. Hou SH: Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis 1994;23:60–63.
  42. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G: Pregnancy and dialysis. Am J Kidney Dis 1998;31:756–765.
  43. Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T: Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant 1999;14:1511–1516.
  44. Roxe DM, McLaughlin MM: Reproductive capacity in female patients on chronic hemodialysis. Int J Artif Organs 1984;7:249–250.
  45. Redrow M, Cherem L, Elliott J, Mangalat J, Mishler RE, Bennett WM, Lutz M, Sigala J, Byrnes J, Phillipe M: Dialysis in the management of pregnant patients with renal insufficiency. Medicine (Baltimore) 1988;67:199–208.
  46. Giatras I, Levy DP, Malone FD, Carlson JA, Jungers P: Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant 1998;13:3266–3272.
  47. Romao JE, Jr., Luders C, Kahhale S, Pascoal IJ, Abensur H, Sabbaga E, Zugaib M, Marcondes M: Pregnancy in women on chronic dialysis. A single-center experience with 17 cases. Nephron 1998;78:416–422.
  48. Nakabayashi M, Adachi T, Itoh S, Kobayashi M, Mishina J, Nishida H: Perinatal and infant outcome of pregnant patients undergoing chronic hemodialysis. Nephron 1999;82:27–31.
  49. Reister F, Reister B, Heyl W, Riehl J, Schroder W, Mann H, Rath W: Dialysis and pregnancy – A case report and review of the literature. Ren Fail 1999;21:533–539.
  50. Barua M, Hladunewich M, Keunen J, Pierratos A, McFarlane P, Sood M, Chan CT: Successful pregnancies on nocturnal home hemodialysis. Clin J Am Soc Nephrol 2008;3:392–396.
  51. Bamberg C, Diekmann F, Haase M, Budde K, Hocher B, Halle H, Hartung J: Pregnancy on intensified hemodialysis: fetal surveillance and perinatal outcome. Fetal Diagn Ther 2007;22:289–293.
  52. Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, Diekmann F, Dragun D, Peters H, Neumayer HH, Budde K: A systematic approach to managing pregnant dialysis patients – The importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005;20:2537–2542.
  53. Villa G, Montagna G, Segagni S: Pregnancy in chronic dialysis. A case report and a review of the literature. G Ital Nefrol 2007;24:132–140.
  54. Gangji AS, Windrim R, Gandhi S, Silverman JA, Chan CT: Successful pregnancy with nocturnal hemodialysis. Am J Kidney Dis 2004;44:912–916.
  55. Oosterhof H, Navis GJ, Go JG, Dassel AC, de Jong PE, Aarnoudse JG: Pregnancy in a patient on chronic haemodialysis: fetal monitoring by Doppler velocimetry of the umbilical artery. Br J Obstet Gynaecol 1993;100:1140–1141.
  56. Stratta P, Canavese C, Giacchino F, Mesiano P, Quaglia M, Rossetti M: Pregnancy in kidney transplantation: satisfactory outcomes and harsh realities. J Nephrol 2003;16:792–806.
  57. Holley JL, Reddy SS: Pregnancy in dialysis patients: a review of outcomes, complications, and management. Semin Dial 2003;16:384–388.
  58. Giofre F, Pugliese C, Alati G, Messina A, Tramontana D: Three successive pregnancies in a patient with chronic renal disease progressing from chronic renal dysfunction through to institution of dialysis during pregnancy and then on to maintenance dialysis. Nephrol Dial Transplant 2007;22:1236–1240.
  59. Rizzoni G, Ehrich JH, Broyer M, Brunner FP, Brynger H, Fassbinder W, Geerlings W, Selwood NH, Tufveson G, Wing AJ: Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry. Nephrol Dial Transplant 1992;7:279–287.
  60. Tuot D, Gibson S, Caughey AB, Frassetto LA: Intradialytic hyperalimentation as adjuvant support in pregnant hemodialysis patients: case report and review of the literature. Int Urol Nephrol 2010;42:233–237.
  61. Hou S, Firanek C: Management of the pregnant dialysis patient. Adv Ren Replace Ther 1998;5:24–30.
  62. Chang H, Miller MA, Bruns FJ: Tidal peritoneal dialysis during pregnancy improves clearance and abdominal symptoms. Perit Dial Int 2002;22:272–274.
  63. Gómez Vázquez JA, Martínez Calva IE, Mendíola Fernández R, Escalera León V, Cardona M, Noyola H: Pregnancy in end-stage renal disease patients and treatment with peritoneal dialysis: report of two cases. Perit Dial Int 2007;27:353–358.
  64. Sibanda N, Briggs JD, Davison JM, Johnson RJ, Rudge CJ: Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation 2007;83:1301–1307.
  65. First MR, Combs CA, Weiskittel P, Miodovnik M: Lack of effect of pregnancy on renal allograft survival or function. Transplantation 1995;59:472–476.
  66. Miranda CT, Melaragno C, Camara NO, Pacheco-Silva A, Medina-Pestana PJ: Adverse effects of pregnancy on renal allograft function. Transplant Proc 2002;34:506–507.
  67. Sturgiss SN, Davison JM: Effect of pregnancy on the long-term function of renal allografts: an update. Am J Kidney Dis 1995;26:54–56.
  68. Kim HW, Seok HJ, Kim TH, Han DJ, Yang WS, Park SK: The experience of pregnancy after renal transplantation: pregnancies even within postoperative 1 year may be tolerable. Transplantation 2008;85:1412–1419.
  69. Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, Hecker WP, Lavelanet A, McGrory CH, Coscia LA: Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl 2004:103–114.

    External Resources

  70. Davison JM, Bailey DJ: Pregnancy following renal transplantation. J Obstet Gynaecol Res 2003;29:227–233.
  71. Davison JM, Milne JE: Pregnancy and renal transplantation. Br J Urol 1997;80(suppl 1): 29–32.

    External Resources

  72. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.
  73. McKay DB, Josephson MA: Pregnancy in recipients of solid organs – Effects on mother and child. N Engl J Med 2006;354:1281–1293.
  74. Le Ray C, Coulomb A, Elefant E, Frydman R, Audibert F: Mycophenolate mofetil in pregnancy after renal transplantation: a case of major fetal malformations. Obstet Gynecol 2004;103:1091–1094.
  75. Guardia O, Rial MC, Casadei D: Pregnancy under sirolimus-based immunosuppression. Transplantation 2006;81:636.
  76. Chen X, He J, Ding Y, Zeng L, Gao R, Cheng S, Liu X, Wang Y: The role of MTOR in mouse uterus during embryo implantation. Reproduction 2009;138:351–356.
  77. Gaughan WJ, Moritz MJ, Radomski JS, Burke JF Jr, Armenti VT: National Transplantation Pregnancy Registry: report on outcomes in cyclosporine-treated female kidney transplant recipients with an interval from transplant to pregnancy of greater than five years. Am J Kidney Dis 1996;28:266–269.
  78. Armenti VT, Moritz MJ, Davison JM: Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. Drug Saf 1998;19:219–232.
  79. Jain AB, Shapiro R, Scantlebury VP, Potdar S, Jordan ML, Flohr J, Marcos A, Fung JJ: Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center’s experience. Transplantation 2004;77:897–902.
  80. European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol Dial Transplant 2002;17(suppl 4):50–55.

    External Resources

  81. Flechner SM, Katz AR, Rogers AJ, Van BC, Kahan BD: The presence of cyclosporine in body tissues and fluids during pregnancy. Am J Kidney Dis 1985;5:60–63.
  82. Shaheen FA, al-Sulaiman MH, al-Khader AA: Long-term nephrotoxicity after exposure to cyclosporine in utero. Transplantation 1993;56:224–225.
  83. Jain A, Venkataramanan R, Fung JJ, Gartner JC, Lever J, Balan V, Warty V, Starzl TE: Pregnancy after liver transplantation under tacrolimus. Transplantation 1997;64:559–565.
  84. Farley DE, Shelby J, Alexander D, Scott JR: The effect of two new immunosuppressive agents, FK506 and didemnin B, in murine pregnancy. Transplantation 1991;52:106–110.
  85. Fein A, Vechoropoulos M, Nebel L: Cyclosporin-induced embryotoxicity in mice. Biol Neonate 1989;56:165–173.
  86. Mason RJ, Thomson AW, Whiting PH, Gray ES, Brown PA, Catto GR, Simpson JG: Cyclosporine-induced fetotoxicity in the rat. Transplantation 1985;39:9–12.
  87. Perez-Aytes A, Ledo A, Boso V, Saenz P, Roma E, Poveda JL, Vento M: In utero exposure to mycophenolate mofetil: a characteristic phenotype? Am J Med Genet A 2008;146A:1–7.
  88. Merlob P, Stahl B, Klinger G: Tetrada of the possible mycophenolate mofetil embryopathy: a review. Reprod Toxicol 2009;28:105–108.
  89. Anderka MT, Lin AE, Abuelo DN, Mitchell AA, Rasmussen SA: Reviewing the evidence for mycophenolate mofetil as a new teratogen: case report and review of the literature. Am J Med Genet A 2009;149A:1241–1248.
  90. Parisi MA, Zayed H, Slavotinek AM, Rutledge JC: Congenital diaphragmatic hernia and microtia in a newborn with mycophenolate mofetil (MMF) exposure: phenocopy for Fryns syndrome or broad spectrum of teratogenic effects? Am J Med Genet A 2009;149A:1237–1240.

  

Author Contacts

Prof. Loreto Gesualdo
Nephrology, Dialysis and Transplantation Unit
University of Bari, Policlinico, Piazza Giulio Cesare 11
IT–70124 Bari (Italy)
E-Mail l.gesualdo@nephro.uniba.it

  

Article Information

Published online: June 21, 2011
Number of Print Pages : 8
Number of Figures : 0, Number of Tables : 0, Number of References : 90

  

Publication Details

Kidney and Blood Pressure Research

Vol. 34, No. 4, Year 2011 (Cover Date: June 2011)

Journal Editor: Tesar V. (Prague)
ISSN: 1420-4096 (Print), eISSN: 1423-0143 (Online)

For additional information: http://www.karger.com/KBR


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References

  1. Williams D, Davison J: Chronic kidney disease in pregnancy. BMJ 2008;336:211–215.
  2. Hou S: Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999;33:235–252.
  3. Baylis C: Glomerular filtration and volume regulation in gravid animal models. Baillieres Clin Obstet Gynaecol 1994;8:235–264.
  4. Maynard SE, Thadhani R: Pregnancy and the kidney. J Am Soc Nephrol 2009;20:14–22.
  5. Smith MC, Moran P, Ward MK, Davison JM: Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG 2008;115:109–112.
  6. Alper AB, Yi Y, Webber LS, Pridjian G, Mumuney AA, Saade G, Morgan J, Nuwayhid B, Belfort M, Puschett J: Estimation of glomerular filtration rate in preeclamptic patients. Am J Perinatol 2007;24:569–574.
  7. Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG: Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004;141:929–937.
  8. Eknoyan G, Hostetter T, Bakris GL, Hebert L, Levey AS, Parving HH, Steffes MW, Toto R: Proteinuria and other markers of chronic kidney disease: a position statement of the national kidney foundation (NKF) and the national institute of diabetes and digestive and kidney diseases (NIDDK). Am J Kidney Dis 2003;42:617–622.
  9. Imbasciati E, Pardi G, Capetta P, Ambroso G, Bozzetti P, Pagliari B, Ponticelli C: Pregnancy in women with chronic renal failure. Am J Nephrol 1986;6:193–198.
  10. Purdy LP, Hantsch CE, Molitch ME, Metzger BE, Phelps RL, Dooley SL, Hou SH: Effect of pregnancy on renal function in patients with moderate-to-severe diabetic renal insufficiency. Diabetes Care 1996;19:1067–1074.
  11. Jones DC, Hayslett JP: Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996;335:226–232.
  12. Sanders CL, Lucas MJ: Renal disease in pregnancy. Obstet Gynecol Clin North Am 2001;28:593–600, vii.
  13. Imbasciati E, Gregorini G, Cabiddu G, Gammaro L, Ambroso G, Del Giudice A, Ravani P: Pregnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kidney Dis 2007;49:753–762.
  14. Piccoli GB, Attini R, Vasario E, Conijn A, Biolcati M, D’Amico F, Consiglio V, Bontempo S, Todros T: Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol 2010;5:844–855.
  15. McArdle A, Maduwegedera D, Moritz K, Flower RL, Denton KM, Roberts CT: Chronic maternal hypertension affects placental gene expression and differentiation in rabbits. J Hypertens 2010;28:959–968.
  16. McArdle AM, Roberts CT, Maduwegedera D, Flower RL, Denton KM: Chronic maternal hypertension characterized by renal dysfunction is associated with reduced placental blood flow during late gestation in rabbits. Am J Physiol Regul Integr Comp Physiol 2010;298:R1043–R1049.
  17. Laube GF, Kemper MJ, Schubiger G, Neuhaus TJ: Angiotensin-converting enzyme inhibitor fetopathy: long-term outcome. Arch Dis Child Fetal Neonatal Ed 2007;92:F402–F403.
  18. Alwan S, Polifka JE, Friedman JM: Angiotensin II receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol 2005;73:123–130.
  19. Baumwell S, Karumanchi SA: Pre-eclampsia: clinical manifestations and molecular mechanisms. Nephron Clin Pract 2007;106:c72–c81.
  20. Cornelis T, Odutayo A, Keunen J, Hladunewich M: The kidney in normal pregnancy and preeclampsia. Semin Nephrol 2011;31:4–14.
  21. Maynard SE, Min JY, Merchan J, Lim KH, Li J, Mondal S, Libermann TA, Morgan JP, Sellke FW, Stillman IE, Epstein FH, Sukhatme VP, Karumanchi SA: Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Invest 2003;111:649–658.
  22. Levine RJ, Lam C, Qian C, Yu KF, Maynard SE, Sachs BP, Sibai BM, Epstein FH, Romero R, Thadhani R, Karumanchi SA: Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med 2006;355:992–1005.
  23. Levine RJ, Maynard SE, Qian C, Lim KH, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA: Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004;350:672–683.
  24. Moore Simas TA, Crawford SL, Solitro MJ, Frost SC, Meyer BA, Maynard SE: Angiogenic factors for the prediction of preeclampsia in high-risk women. Am J Obstet Gynecol 2007;197:244–248.
  25. Vikse BE, Irgens LM, Leivestad T, Skjaerven R, Iversen BM: Preeclampsia and the risk of end-stage renal disease. N Engl J Med 2008;359:800–809.
  26. Gilbert JS, Verzwyvelt J, Colson D, Arany M, Karumanchi SA, Granger JP: Recombinant vascular endothelial growth factor 121 infusion lowers blood pressure and improves renal function in rats with placentalischemia-induced hypertension. Hypertension 2010;55:380–385.
  27. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA: Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007;369:1791–1798.
  28. Limardo M, Imbasciati E, Ravani P, Surian M, Torres D, Gregorini G, Magistroni R, Casellato D, Gammaro L, Pozzi C: Pregnancy and progression of IgA nephropathy: results of an Italian multicenter study. Am J Kidney Dis 2010;56:506–512.
  29. Goldstein AR, White RH, Akuse R, Chantler C: Long-term follow-up of childhood Henoch-Schönlein nephritis. Lancet 1992;339:280–282.
  30. Ronkainen J, Nuutinen M, Koskimies O: The adult kidney 24 years after childhood Henoch-Schönlein purpura: a retrospective cohort study. Lancet 2002;360:666–670.
  31. Kalmantis K, Daskalakis G, Iavazzo C, Vranos A, Mesogitis S, Antsaklis A: Henoch-Schönlein purpura in pregnancy. J Obstet Gynaecol 2008;28:403–405.
  32. Keeling SO, Oswald AE: Pregnancy and rheumatic disease: ‘by the book’ or ‘by the doc’. Clin Rheumatol 2009;28:1–9.
  33. Day CJ, Lipkin GW, Savage CO: Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 2009;24:344–347.
  34. Clowse ME: Lupus activity in pregnancy. Rheum Dis Clin North Am 2007;33:237–52, v.
  35. Clowse ME, Jamison M, Myers E, James AH: A national study of the complications of lupus in pregnancy. Am J Obstet Gynecol 2008;199:127.e1–6.
  36. Wagner SJ, Craici I, Reed D, Norby S, Bailey K, Wiste HJ, Wood CM, Moder KG, Liang KP, Liang KV, Rose C, Rozkos T, Sitina M, Grande JP, Garovic VD: Maternal and foetal outcomes in pregnant patients with active lupus nephritis. Lupus 2009;18:342–347.
  37. Carmona F, Font J, Moga I, Lazaro I, Cervera R, Pac V, Balasch J: Class III-IV proliferative lupus nephritis and pregnancy: a study of 42 cases. Am J Reprod Immunol 2005;53:182–188.
  38. Bolignano D, Coppolino G, Crasci E, Campo S, Aloisi C, Buemi M: Pregnancy in uremic patients: an eventful journey. J Obstet Gynaecol Res 2008;34:137–143.
  39. Vidaeff AC, Yeomans ER, Ramin SM: Pregnancy in women with renal disease. 1. General principles. Am J Perinatol 2008;25:385–397.
  40. Souqiyyeh MZ, Huraib SO, Saleh AG, Aswad S: Pregnancy in chronic hemodialysis patients in the Kingdom of Saudi Arabia. Am J Kidney Dis 1992;19:235–238.
  41. Hou SH: Frequency and outcome of pregnancy in women on dialysis. Am J Kidney Dis 1994;23:60–63.
  42. Bagon JA, Vernaeve H, De Muylder X, Lafontaine JJ, Martens J, Van Roost G: Pregnancy and dialysis. Am J Kidney Dis 1998;31:756–765.
  43. Toma H, Tanabe K, Tokumoto T, Kobayashi C, Yagisawa T: Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey. Nephrol Dial Transplant 1999;14:1511–1516.
  44. Roxe DM, McLaughlin MM: Reproductive capacity in female patients on chronic hemodialysis. Int J Artif Organs 1984;7:249–250.
  45. Redrow M, Cherem L, Elliott J, Mangalat J, Mishler RE, Bennett WM, Lutz M, Sigala J, Byrnes J, Phillipe M: Dialysis in the management of pregnant patients with renal insufficiency. Medicine (Baltimore) 1988;67:199–208.
  46. Giatras I, Levy DP, Malone FD, Carlson JA, Jungers P: Pregnancy during dialysis: case report and management guidelines. Nephrol Dial Transplant 1998;13:3266–3272.
  47. Romao JE, Jr., Luders C, Kahhale S, Pascoal IJ, Abensur H, Sabbaga E, Zugaib M, Marcondes M: Pregnancy in women on chronic dialysis. A single-center experience with 17 cases. Nephron 1998;78:416–422.
  48. Nakabayashi M, Adachi T, Itoh S, Kobayashi M, Mishina J, Nishida H: Perinatal and infant outcome of pregnant patients undergoing chronic hemodialysis. Nephron 1999;82:27–31.
  49. Reister F, Reister B, Heyl W, Riehl J, Schroder W, Mann H, Rath W: Dialysis and pregnancy – A case report and review of the literature. Ren Fail 1999;21:533–539.
  50. Barua M, Hladunewich M, Keunen J, Pierratos A, McFarlane P, Sood M, Chan CT: Successful pregnancies on nocturnal home hemodialysis. Clin J Am Soc Nephrol 2008;3:392–396.
  51. Bamberg C, Diekmann F, Haase M, Budde K, Hocher B, Halle H, Hartung J: Pregnancy on intensified hemodialysis: fetal surveillance and perinatal outcome. Fetal Diagn Ther 2007;22:289–293.
  52. Haase M, Morgera S, Bamberg C, Halle H, Martini S, Hocher B, Diekmann F, Dragun D, Peters H, Neumayer HH, Budde K: A systematic approach to managing pregnant dialysis patients – The importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005;20:2537–2542.
  53. Villa G, Montagna G, Segagni S: Pregnancy in chronic dialysis. A case report and a review of the literature. G Ital Nefrol 2007;24:132–140.
  54. Gangji AS, Windrim R, Gandhi S, Silverman JA, Chan CT: Successful pregnancy with nocturnal hemodialysis. Am J Kidney Dis 2004;44:912–916.
  55. Oosterhof H, Navis GJ, Go JG, Dassel AC, de Jong PE, Aarnoudse JG: Pregnancy in a patient on chronic haemodialysis: fetal monitoring by Doppler velocimetry of the umbilical artery. Br J Obstet Gynaecol 1993;100:1140–1141.
  56. Stratta P, Canavese C, Giacchino F, Mesiano P, Quaglia M, Rossetti M: Pregnancy in kidney transplantation: satisfactory outcomes and harsh realities. J Nephrol 2003;16:792–806.
  57. Holley JL, Reddy SS: Pregnancy in dialysis patients: a review of outcomes, complications, and management. Semin Dial 2003;16:384–388.
  58. Giofre F, Pugliese C, Alati G, Messina A, Tramontana D: Three successive pregnancies in a patient with chronic renal disease progressing from chronic renal dysfunction through to institution of dialysis during pregnancy and then on to maintenance dialysis. Nephrol Dial Transplant 2007;22:1236–1240.
  59. Rizzoni G, Ehrich JH, Broyer M, Brunner FP, Brynger H, Fassbinder W, Geerlings W, Selwood NH, Tufveson G, Wing AJ: Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry. Nephrol Dial Transplant 1992;7:279–287.
  60. Tuot D, Gibson S, Caughey AB, Frassetto LA: Intradialytic hyperalimentation as adjuvant support in pregnant hemodialysis patients: case report and review of the literature. Int Urol Nephrol 2010;42:233–237.
  61. Hou S, Firanek C: Management of the pregnant dialysis patient. Adv Ren Replace Ther 1998;5:24–30.
  62. Chang H, Miller MA, Bruns FJ: Tidal peritoneal dialysis during pregnancy improves clearance and abdominal symptoms. Perit Dial Int 2002;22:272–274.
  63. Gómez Vázquez JA, Martínez Calva IE, Mendíola Fernández R, Escalera León V, Cardona M, Noyola H: Pregnancy in end-stage renal disease patients and treatment with peritoneal dialysis: report of two cases. Perit Dial Int 2007;27:353–358.
  64. Sibanda N, Briggs JD, Davison JM, Johnson RJ, Rudge CJ: Pregnancy after organ transplantation: a report from the UK Transplant pregnancy registry. Transplantation 2007;83:1301–1307.
  65. First MR, Combs CA, Weiskittel P, Miodovnik M: Lack of effect of pregnancy on renal allograft survival or function. Transplantation 1995;59:472–476.
  66. Miranda CT, Melaragno C, Camara NO, Pacheco-Silva A, Medina-Pestana PJ: Adverse effects of pregnancy on renal allograft function. Transplant Proc 2002;34:506–507.
  67. Sturgiss SN, Davison JM: Effect of pregnancy on the long-term function of renal allografts: an update. Am J Kidney Dis 1995;26:54–56.
  68. Kim HW, Seok HJ, Kim TH, Han DJ, Yang WS, Park SK: The experience of pregnancy after renal transplantation: pregnancies even within postoperative 1 year may be tolerable. Transplantation 2008;85:1412–1419.
  69. Armenti VT, Radomski JS, Moritz MJ, Gaughan WJ, Hecker WP, Lavelanet A, McGrory CH, Coscia LA: Report from the National Transplantation Pregnancy Registry (NTPR): outcomes of pregnancy after transplantation. Clin Transpl 2004:103–114.

    External Resources

  70. Davison JM, Bailey DJ: Pregnancy following renal transplantation. J Obstet Gynaecol Res 2003;29:227–233.
  71. Davison JM, Milne JE: Pregnancy and renal transplantation. Br J Urol 1997;80(suppl 1): 29–32.

    External Resources

  72. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.
  73. McKay DB, Josephson MA: Pregnancy in recipients of solid organs – Effects on mother and child. N Engl J Med 2006;354:1281–1293.
  74. Le Ray C, Coulomb A, Elefant E, Frydman R, Audibert F: Mycophenolate mofetil in pregnancy after renal transplantation: a case of major fetal malformations. Obstet Gynecol 2004;103:1091–1094.
  75. Guardia O, Rial MC, Casadei D: Pregnancy under sirolimus-based immunosuppression. Transplantation 2006;81:636.
  76. Chen X, He J, Ding Y, Zeng L, Gao R, Cheng S, Liu X, Wang Y: The role of MTOR in mouse uterus during embryo implantation. Reproduction 2009;138:351–356.
  77. Gaughan WJ, Moritz MJ, Radomski JS, Burke JF Jr, Armenti VT: National Transplantation Pregnancy Registry: report on outcomes in cyclosporine-treated female kidney transplant recipients with an interval from transplant to pregnancy of greater than five years. Am J Kidney Dis 1996;28:266–269.
  78. Armenti VT, Moritz MJ, Davison JM: Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. Drug Saf 1998;19:219–232.
  79. Jain AB, Shapiro R, Scantlebury VP, Potdar S, Jordan ML, Flohr J, Marcos A, Fung JJ: Pregnancy after kidney and kidney-pancreas transplantation under tacrolimus: a single center’s experience. Transplantation 2004;77:897–902.
  80. European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. IV.10. Pregnancy in renal transplant recipients. Nephrol Dial Transplant 2002;17(suppl 4):50–55.

    External Resources

  81. Flechner SM, Katz AR, Rogers AJ, Van BC, Kahan BD: The presence of cyclosporine in body tissues and fluids during pregnancy. Am J Kidney Dis 1985;5:60–63.
  82. Shaheen FA, al-Sulaiman MH, al-Khader AA: Long-term nephrotoxicity after exposure to cyclosporine in utero. Transplantation 1993;56:224–225.
  83. Jain A, Venkataramanan R, Fung JJ, Gartner JC, Lever J, Balan V, Warty V, Starzl TE: Pregnancy after liver transplantation under tacrolimus. Transplantation 1997;64:559–565.
  84. Farley DE, Shelby J, Alexander D, Scott JR: The effect of two new immunosuppressive agents, FK506 and didemnin B, in murine pregnancy. Transplantation 1991;52:106–110.
  85. Fein A, Vechoropoulos M, Nebel L: Cyclosporin-induced embryotoxicity in mice. Biol Neonate 1989;56:165–173.
  86. Mason RJ, Thomson AW, Whiting PH, Gray ES, Brown PA, Catto GR, Simpson JG: Cyclosporine-induced fetotoxicity in the rat. Transplantation 1985;39:9–12.
  87. Perez-Aytes A, Ledo A, Boso V, Saenz P, Roma E, Poveda JL, Vento M: In utero exposure to mycophenolate mofetil: a characteristic phenotype? Am J Med Genet A 2008;146A:1–7.
  88. Merlob P, Stahl B, Klinger G: Tetrada of the possible mycophenolate mofetil embryopathy: a review. Reprod Toxicol 2009;28:105–108.
  89. Anderka MT, Lin AE, Abuelo DN, Mitchell AA, Rasmussen SA: Reviewing the evidence for mycophenolate mofetil as a new teratogen: case report and review of the literature. Am J Med Genet A 2009;149A:1241–1248.
  90. Parisi MA, Zayed H, Slavotinek AM, Rutledge JC: Congenital diaphragmatic hernia and microtia in a newborn with mycophenolate mofetil (MMF) exposure: phenocopy for Fryns syndrome or broad spectrum of teratogenic effects? Am J Med Genet A 2009;149A:1237–1240.