Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question)
- 作者：Giorgina Barbara Piccoli ; Gianfranca Cabiddu…
- 关键词：Preeclampsia ; Pregnancy ; Hypertension ; Chronic kidney disease ; Pregnancy outcomes
- 刊名：Current Hypertension Reports
- 出版年：2016
- 出版时间：April 2016
- 年：2016
- 卷：18
- 期：5
- 全文大小：1,115 KB
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Piccoli GB, Cabiddu G, Attini R, et al. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol. 2015;26(8):2011–22. A large prospective cohort study, on over 500 singleton pregnancies, highlighting the risks of adverse pregnancy outcomes, in particular in those early CKD stages often considered as of lesser relevance with respect to pregnancy outcomes.CrossRef PubMed
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文摘
Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3 %, while the prevalence of chronic hypertension is about 5–8 %. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.
