학술논문
Pregnancy Outcomes after Clinical Recovery from AKI.
Document Type
Academic Journal
Author
Tangren JS; Division of Nephrology, Department of Medicine, jtangren@partners.org.; Powe CE; Division of Endocrinology, Department of Medicine, and.; Ankers E; Division of Nephrology, Department of Medicine.; Ecker J; Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts.; Bramham K; Department of Renal Medicine, King's College London and King's Health Partners, London, United Kingdom.; Hladunewich MA; Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; and.; Karumanchi SA; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.; Thadhani R; Division of Nephrology, Department of Medicine.
Source
Publisher: Wolters Kluwer Health, on behalf of the American Society of Nephrology Country of Publication: United States NLM ID: 9013836 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1533-3450 (Electronic) Linking ISSN: 10466673 NLM ISO Abbreviation: J Am Soc Nephrol Subsets: MEDLINE
Subject
Language
English
Abstract
The effect of clinically recovered AKI (r-AKI) on future pregnancy outcomes is unknown. We retrospectively studied all women who delivered infants between 1998 and 2007 at Massachusetts General Hospital to assess whether a previous episode of r-AKI associated with subsequent adverse maternal and fetal outcomes, including preeclampsia. AKI was defined as rise in serum creatinine concentration to 1.5-fold above baseline. We compared pregnancy outcomes in women with r-AKI without history of CKD (eGFR>90 ml/min per 1.73 m 2 before conception; n =105) with outcomes in women without kidney disease (controls; n =24,640). The r-AKI and control groups had similar prepregnancy serum creatinine measurements (0.70±0.20 versus 0.69±0.10 mg/dl; P =0.36). However, women with r-AKI had increased rates of preeclampsia compared with controls (23% versus 4%; P <0.001). Infants of women with r-AKI were born earlier than infants of controls (37.6±3.6 versus 39.2±2.2 weeks; P <0.001), with increased rates of small for gestational age births (15% versus 8%; P =0.03). After multivariate adjustment, r-AKI associated with increased risk for preeclampsia (adjusted odds ratio [aOR], 5.9; 95% confidence interval [95% CI], 3.6 to 9.7) and adverse fetal outcomes (aOR, 2.4; 95% CI, 1.6 to 3.7). When women with r-AKI and controls were matched 1:2 by age, race, body mass index, diastolic BP, parity, and diabetes status, r-AKI remained associated with preeclampsia (OR, 4.7; 95% CI, 2.1 to 10.1) and adverse fetal outcomes (OR, 2.1; 95% CI, 1.2 to 3.7). Thus, a past episode of AKI, despite return to normal renal function before pregnancy, associated with adverse outcomes in pregnancy.
(Copyright © 2017 by the American Society of Nephrology.)
(Copyright © 2017 by the American Society of Nephrology.)