Kidney Disease in Pregnancy

2017 ◽  
Author(s):  
Kavitha Vellanki ◽  
Susan Hou
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Filtration Rate ◽  
Kidney Biopsy ◽  
End Stage Kidney Disease ◽  
Proliferative Lupus Nephritis ◽  
End Stage

Pregnancy-induced changes in renal hemodynamics play an important role in favorable maternal and fetal outcomes. Renal plasma flow and glomerular filtration rate (GFR) increase by approximately 50% in normal pregnancy, leading to a decrease in both blood urea nitrogen and serum creatinine when compared with prepregnancy levels. Hence, serum creatinine–based formulas are not accurate in calculating estimated GFR in pregnant patients. The most compelling risk for pregnant women with moderate to severe chronic kidney disease is the risk of rapid progression of underlying kidney disease; the mechanisms for such decline are yet to be elucidated. The rule of kidney disease not progressing when serum creatinine is less than 1.4 mg/dL does not apply to women with lupus nephritis. New-onset lupus is an indication for kidney biopsy during pregnancy because diffuse proliferative lupus nephritis requires prompt treatment and first-line treatments are teratogenic. Infertility is common in women on dialysis and is usually reversed after successful kidney transplantation. Pregnancy outcomes have improved over the years with increasing intensity of hemodialysis in end-stage kidney disease patients. Pregnancy post–kidney transplantation should be planned and teratogenic medications discontinued before conception. Key words: glomerular filtration rate, proliferative lupus nephritis, serum creatinine, pregnancy post–kidney transplantation, end-stage kidney disease, infertility, kidney biopsy

Trajectories of glomerular filtration rate and progression to end stage kidney disease after kidney transplantation

2021 ◽  
Vol 99 (1) ◽  
pp. 186-197 ◽  
Author(s):  
Marc Raynaud ◽  
Olivier Aubert ◽  
Peter P. Reese ◽  
Yassine Bouatou ◽  
Maarten Naesens ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
End Stage Kidney Disease ◽  
End Stage

scholarly journals Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis: Focus on Children, Adolescents, and Young Adults

2009 ◽  
Vol 4 (12) ◽  
pp. 1962-1967 ◽  
Author(s):  
Keisha L. Gibson ◽  
Debbie S. Gipson ◽  
Susan A. Massengill ◽  
Mary Anne Dooley ◽  
William A. Primack ◽  
...  
Keyword(s):  
Young Adults ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Adolescents And Young Adults ◽  
End Stage Kidney Disease ◽  
Proliferative Lupus Nephritis ◽  
End Stage

Kidney Disease in Pregnancy

2017 ◽  
Author(s):  
Kavitha Vellanki ◽  
Susan Hou
Keyword(s):  
Kidney Transplantation ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Serum Creatinine ◽  
Renal Plasma Flow ◽  
Normal Pregnancy ◽  
Rapid Progression ◽  
Severe Chronic Kidney Disease ◽  
End Stage ◽  
Induced Changes

Pregnancy-induced changes in renal hemodynamics play an important role in favorable maternal and fetal outcomes. Renal plasma flow and glomerular filtration rate (GFR) increase by approximately 50% in normal pregnancy, leading to a decrease in both blood urea nitrogen and serum creatinine when compared with prepregnancy levels. Hence, serum creatinine–based formulas are not accurate in calculating estimated GFR in pregnant patients. The most compelling risk for pregnant women with moderate to severe chronic kidney disease is the risk of rapid progression of underlying kidney disease; the mechanisms for such decline are yet to be elucidated. The rule of kidney disease not progressing when serum creatinine is less than 1.4 mg/dL does not apply to women with lupus nephritis. New-onset lupus is an indication for kidney biopsy during pregnancy because diffuse proliferative lupus nephritis requires prompt treatment and first-line treatments are teratogenic. Infertility is common in women on dialysis and is usually reversed after successful kidney transplantation. Pregnancy outcomes have improved over the years with increasing intensity of hemodialysis in end-stage kidney disease patients. Pregnancy post–kidney transplantation should be planned and teratogenic medications discontinued before conception.

scholarly journals P1713A CASE OF DEVASTATING BARIATRIC SURGERY-RELATED ACUTE OXALATE NEPHROPATHY FIRST DIAGNOSED AFTER KIDNEY TRANSPLANTATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Francesca Santarsia ◽  
Ilaria Gandolfini ◽  
Marco Delsante ◽  
Alessandra Palmisano ◽  
Francesco Peyronel ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Kidney Transplantation ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Calcium Oxalate ◽  
High Dose ◽  
End Stage Kidney Disease ◽  
History Of ◽  
End Stage ◽  
Oxalate Nephropathy

Abstract Background and Aims Despite the obvious efficacy in achieving weight loss, traditional malabsorptive procedures (intestinal by-pass) used for the treatment of obesity, may be associated with enteric oxaluria. Enteric oxaluria, by causing calcium-oxalate stones and nephrocalcinosis, represents an under-recognized cause of end-stage kidney disease in patients with history of intestinal by-pass. Herein, we describe a patient with a long-standing history of intestinal by-pass who developed a devastating acute oxalate nephropathy first diagnosed after kidney transplantation. Method A white female aged 50, who started hemodialysis one year earlier because of tubule-interstitial nephritis on a kidney biopsy, and who had history of recurrent kidney stones (calcium oxalate), underwent urgent deceased-donor kidney transplantation because of exhausted vascular access for hemodialysis (tunneled CVC right giugular vein as the last resort). She had received intestinal by-pass surgery 20 yrs earlier, and had a pacemaker implantation in the left sublavian vein for AV block two years earlier. She was highly sensitized because of blood transfusions at the time of surgery. Results After transplantation, graft function had immediate recovery, serum creatinine decreasing to 2.0mg/dL (117 mmol/L) on post-operative day (POD) 3. Shortly after, serum creatinine started rising until it reached 4.0mg/dL (354mmol/L) on POD 5. Three graft biopsies (performed on POD 6, 9 and 15 post-transplant) revealed acute oxalate nephropathy ( Figure1-2 large oxalate crystals on fresh unfixed core of kidney tissue analyzed under bright field microscope using polarized light) with no sign of rejection. Serial monitoring of Luminex SAB did not reveal circulating anti-HLA donor specific antibodies. Fundus examination revealed two tiny mono-lateral retinal oxalate deposits, whereas bone biopsy did not reveal oxalate accumulation. Plasma oxalate levels were 43 mmol/L on POD 10 were urinary oxalate excretion was 29mg /day on POD 14. The patient slowly progressed to end-stage kidney disease 2-month post-transplantation despite daily high flux dialysis since POD 7, fat-free and oxalate-free diet, oral potassium and high dose pyridoxine supplements. Conclusion Patients on chronic dialysis with a previous history of bariatric surgery via intestinal by-pass may have oxalate nephropathy caused by enteric oxaluria as unknown primary renal disease. The disease may recur shortly after transplantation despite the adoption of prompt aggressive treatment for oxalate removal.

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