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Chronic kidney disease in pregnancy

  • V. Chinnappa
    Affiliations
    Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada
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  • S. Ankichetty
    Affiliations
    Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada
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  • P. Angle
    Affiliations
    Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada

    University of Toronto Obstetrical Anesthesia Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
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  • S.H. Halpern
    Correspondence
    Correspondence to: Dr. Stephen Halpern, Division Head, Obstetrical Anesthesia, Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5.
    Affiliations
    Division of Obstetrical Anesthesia, Sunnybrook Health Sciences Centre, Toronto, Canada

    University of Toronto Obstetrical Anesthesia Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
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      Abstract

      Parturients with renal insufficiency or failure present a significant challenge for the anesthesiologist. Impaired renal function compromises fertility and increases both maternal and fetal morbidity and mortality. Close communication amongst medical specialists, including nephrologists, obstetricians, neonatologists and anesthesiologists is required to ensure the safety of mother and child. Pre-existing diseases should be optimized and close surveillance of maternal and fetal condition is required. Kidney function may deteriorate during pregnancy, necessitating early intervention. The goal is to maintain hemodynamic and physiologic stability while the demands of the pregnancy change. Drugs that may adversely affect the fetus, are nephrotoxic or are dependent on renal elimination should be avoided.

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      References

        • Fischer M.J.
        • Lehnerz S.D.
        • Hebert J.R.
        • Parikh C.R.
        Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy.
        Am J Kidney Dis. 2004; 43: 415-423
        • Ramin S.M.
        • Vidaeff A.C.
        • Yeomans E.R.
        Chronic renal disease in pregnancy.
        Obstet Gynecol. 2006; 108: 1531-1539
        • Nevis I.F.
        • Reitsma A.
        • Dominic A.
        • et al.
        Pregnancy outcomes in women with chronic kidney disease: a systematic review.
        Clin J Am Soc Nephrol. 2011; 6: 2587-2598
        • Christensen T.
        • Klebe J.G.
        • Bertelsen V.
        • et al.
        Changes in renal volume during normal pregnancy.
        Acta Obstet Gynecol Scand. 1989; 68: 541-543
        • Podymow T.
        • August P.
        • Akbari A.
        Management of renal disease in pregnancy.
        Obstet Gynecol Clin North Am. 2010; 37: 195-210
        • Thorsen M.S.
        • Poole J.H.
        Renal disease in pregnancy.
        J Perinat Neonatal Nurs. 2002; 15: 13-26
        • Nurko S.
        Anemia in chronic kidney disease: causes, diagnosis, treatment.
        Cleve Clin J Med. 2006; 73: 289-297
        • Levy A.
        • Fraser D.
        • Katz M.
        • Mazor M.
        • Sheiner E.
        Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.
        Eur J Obstet Gynecol Reprod Biol. 2005; 122: 182-186
        • Asamiya Y.
        • Otsubo S.
        • Matsuda Y.
        • et al.
        The importance of low blood urea nitrogen levels in pregnant patients undergoing hemodialysis to optimize birth weight and gestational age.
        Kidney Int. 2009; 75: 1217-1222
        • Ebstein F.H.
        Pregnancy and renal disease.
        N Engl J Med. 1996; 335: 277-278
        • Vázquez-Rodríguez J.G.
        Hemodialysis and pregnancy: technical aspects.
        Cir Cir. 2010; 78: 99-102
        • Katz A.I.
        • Davison J.M.
        • Hayslett J.P.
        • et al.
        Pregnancy in women with kidney disease.
        Kidney Int. 1980; 18: 192-206
        • Abe S.
        • Amagasaki Y.
        • Konishi K.
        • et al.
        The influence of antecedent renal disease on pregnancy.
        Am J Obstet Gynecol. 1985; 153: 508-514
        • Jungers P.
        • Houillier P.
        • Forget D.
        • et al.
        Influence of pregnancy on the course of primary chronic glomerulonephritis.
        Lancet. 1995; 346: 1122-1124
        • Abe S.
        Pregnancy in IgA nephropathy.
        Kidney Int. 1991; 40: 1098-1102
        • Chopra S.
        • Suri V.
        • Aggarwal N.
        • et al.
        Pregnancy in chronic renal insufficiency: single centre experience from North India.
        Arch Gynecol Obstet. 2009; 279: 691-695
        • Jungers P.
        • Chauveau D.
        • Choukroun G.
        • et al.
        Pregnancy in women with impaired renal function.
        Clin Nephrol. 1997; 47: 281-288
        • Cooper W.O.
        • Hernandez-Diaz S.
        • Arbogast P.G.
        • et al.
        Major congenital malformations after first-trimester exposure to ACE inhibitors.
        N Engl J Med. 2006; 354: 244351
        • Stettler R.W.
        • Cunningham F.G.
        Natural history of chronic proteinuria complicating pregnancy.
        Am J Obstet Gynecol. 1992; 167: 1219-1224
        • Hou S.
        Pregnancy in chronic renal insufficiency and end-stage renal disease.
        Am J Kidney Dis. 1999; 33: 235-252
        • Pandya B.K.
        • Gibson S.P.
        • Robertson I.G.
        Nephrotic syndrome in early pregnancy—is renal biopsy always necessary?.
        Nephrol Dial Transplant. 2002; 17: 672-674
        • Vikse B.E.
        • Irgens L.M.
        • Leivestad T.
        • Skjaerven R.
        • Iversen B.M.
        Pre-eclampsia and the risk of end-stage renal disease.
        N Engl J Med. 2008; 359: 800-809
        • Ekbom P.
        • Damm P.
        • Feldt-Rasmussen B.
        • et al.
        Pregnancy outcome in type 1 diabetic women with microalbuminuria.
        Diabetes Care. 2001; 24: 1739-1744
        • Petri M.
        The Hopkins Lupus Pregnancy Center: ten key issues in management.
        Rheum Dis Clin North Am. 2007; 33: 227-235
        • Braun W.E.
        Autosomal dominant polycystic kidney disease: emerging concepts of pathogenesis and new treatments.
        Cleve Clin J Med. 2009; 76: 97-104
        • Dhir S.
        • Fuller J.
        Case report: pregnancy in hemodialysis-dependent end-stage renal disease: anesthetic considerations.
        Can J Anaesth. 2007; 54: 556-560
        • Hladunewich M.
        • Hercz A.E.
        • Keunen J.
        • Chan C.
        • Pierratos A.
        Pregnancy in end stage renal disease.
        Semin Dial. 2011; 24: 634-639
        • Terasaki P.I.
        • Koyama H.
        • Cecka J.M.
        • Gjertson D.W.
        The hyperfiltration hypothesis in human renal transplantation.
        Transplantation. 1994; 57: 1450-1454
        • Concepcion B.P.
        • Schaefer H.M.
        Caring for the pregnant kidney transplant recipient.
        Clin Transplant. 2011; 25: 821-829
        • Kaitel E.
        • Bruno R.M.
        • Duarte M.
        • et al.
        Pregnancy outcome after renal transplantation.
        Transplant Proc. 2004; 36: 870-871
        • McKay D.B.
        • Josephson M.A.
        Pregnancy after kidney transplantation.
        Clin J Am Soc Nephrol. 2008; 3: S117-25
        • Davison J.M.
        • Lind T.
        • Uldall P.R.
        Planned pregnancy in a renal transplant recipient.
        BJOG. 1976; 83: 518-527
        • McKay D.
        • Josephson M.
        Reproduction and transplantation: report on the AST consensus conference on reproductive issues and transplantation.
        Am J Transplant. 2005; 5: 1592-1599
      1. Beilin Y, Reid RW, Renal disease. In: Chestnut’s Obstetric anesthesia: principles and practice. 4th ed. Philadelphia: 2009. p. 1095–1123.

      2. Berns JS, Coutre S. Platelet dysfunction in uremia. In: Golper TA, editor. Up to date. 2012. www.uptodate.com; [Accessed March 2013].

        • Zacharias M.
        • Conlon N.P.
        • Herbison G.P.
        • Sivalingam P.
        • Walker R.J.
        • Hovhannisyan K.
        Interventions for protecting renal function in the perioperative period.
        Cochrane Database Syst Rev. 2008; 8: CD003590
        • Craig R.G.
        • Hunter J.M.
        Recent developments in the perioperative management of adult patients with chronic kidney disease.
        Br J Anaesth. 2008; 101: 296-310
      3. Reves RJ, Glass PS, Lubarsky DA, McEvoy MD, Martinez-Ruiz M. Intravenous anesthetics. In: Miller RD, editor. Miller’s Anesthesia. 7th ed. Mosby Elsevier; Philadelphia: 2009. p. 719–824.

        • Craig R.G.
        • Hunter J.M.
        Neuromuscular blocking drugs and their antagonists in patients with organ disease.
        Anaesthesia. 2009; 64: 55-65
        • Koehntop D.E.
        • Rodman J.H.
        Fentanyl pharmacokinetics in patients undergoing renal transplantation.
        Pharmacotherapy. 1997; 17: 746-752
        • Jalal D.I.
        • Chonchol M.
        • Targher G.
        Disorders of hemostasis associated with chronic kidney disease.
        Sem Thromb Hemost. 2010; 36: 34-40
        • Basta M.
        • Sloan P.
        Epidural hematoma following epidural catheter placement in a patient with chronic renal failure.
        Can J Anesth. 1999; 46: 271-274
        • Grejda S.
        • Ellis K.
        • Arino P.
        Paraplegia following spinal anesthesia in a patient with chronic renal failure.
        Reg Anesth. 1989; 14: 155-157
      4. Horlocker TT. Wedel DJ, Rowlingson JE, et al. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy. American Society of Regional Anesthesia and Pain Medicine-Based Guidelines, 3rd Ed. Reg Anesth Pain Med, 2010;35:64–101.

        • Bolliger D.
        • Seeberger M.D.
        • Tanaka K.A.
        Principles and practice of thromboelastography in clinical coagulation management and transfusion practice.
        Transfusion Med Rev. 2012; 26: 1-13
        • Aldrete J.A.
        • Gould D.B.
        Bupivacaine cardiotoxicity in a patient with renal failure.
        Acta Anaesthesiol Scand. 1983; 27: 18-21
        • Lucas L.F.
        • Tsueda K.
        Cardiovascular depression after brachial plexus block in two diabetic patients with renal failure.
        Anesthesiology. 1990; 73: 1032-1035
        • Rice A.S.
        • Pither C.E.
        • Tucker G.T.
        Plasma concentrations of bupivacaine after supraclavicular brachial plexus blockade in patients with chronic renal failure.
        Anaesthesia. 1991; 46: 354-357
        • Pere P.J.
        • Ekstrand A.
        • Salonen M.
        • et al.
        Pharmacokinetics of ropivacaine in patients with chronic renal failure.
        Br J Anaesth. 2011; 106: 512-521