Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

Fadi Fakhouri; Nora Schwotzer; Gianfranca Cabiddu; Jonathan Barratt; Hélène Legardeur; Vesna Garovic; Alejandra Orozco-Guillen; Jack Wetzels; Eric Daugas; Gabriella Moroni; Marina Noris; Vincent Audard; Manuel Praga; Elisa Llurba; Grégoire Wuerzner; Rossella Attini; David Desseauve; Elena Zakharova; Claudio Luders; Kate Wiles; Filomena Leone; Shilpanjali Jesudason; Nathalie Costedoat-Chalumeau; Andrea Kattah; Virgilia Soto-Abraham; Alexandre Karras; Jai Prakash; Liz Lightstone; Pierre Ronco; Claudio Ponticelli; Gerald Appel; Giuseppe Remuzzi; Vassilis Tsatsaris; Giorgina Barbara Piccoli

doi:10.1016/j.kint.2022.10.029

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

Kidney Int. 2023 Feb;103(2):264-281. doi: 10.1016/j.kint.2022.10.029. Epub 2022 Dec 5.

Authors

Fadi Fakhouri¹, Nora Schwotzer², Gianfranca Cabiddu³, Jonathan Barratt⁴, Hélène Legardeur⁵, Vesna Garovic⁶, Alejandra Orozco-Guillen⁷, Jack Wetzels⁸, Eric Daugas⁹, Gabriella Moroni¹⁰, Marina Noris¹¹, Vincent Audard¹², Manuel Praga¹³, Elisa Llurba¹⁴, Grégoire Wuerzner², Rossella Attini¹⁵, David Desseauve⁵, Elena Zakharova¹⁶, Claudio Luders¹⁷, Kate Wiles¹⁸, Filomena Leone¹⁹, Shilpanjali Jesudason²⁰, Nathalie Costedoat-Chalumeau²¹, Andrea Kattah²², Virgilia Soto-Abraham²³, Alexandre Karras²⁴, Jai Prakash²⁵, Liz Lightstone²⁶, Pierre Ronco²⁷, Claudio Ponticelli²⁸, Gerald Appel²⁹, Giuseppe Remuzzi¹¹, Vassilis Tsatsaris³⁰, Giorgina Barbara Piccoli³¹

Affiliations

¹ Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland. Electronic address: fadi.fakhouri@unil.ch.
² Service de Néphrologie et d'Hypertension, Département de Médecine, Centre Hospitalier Universitaire Vaudois, and Université de Lausanne, Lausanne, Switzerland.
³ Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Department of Nephrology, San Michele Hospital, ARNAS G. Brotzu, Cagliari, Italy.
⁴ Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
⁵ Gynaecology, Woman Mother Child Department of the Lausanne University Hospital (CHUV), Lausanne, Switzerland.
⁶ Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA; Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
⁷ National Institute of Perinatology Isidro Espinosa de los Reyes (INPER), Department of Nephrology, Ciudad de Mexico, Mexico.
⁸ Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.
⁹ Service de Néphrologie, Hôpital Bichat and Université Paris Cité, Paris, France; Institut national de la santé et de la recherche médicale Inserm U1149, Paris, France.
¹⁰ Department of Biomedical Sciences, Humanitas University, Milan, Italy; Nephrology and Dialysis Division, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy.
¹¹ Istituto di Ricerche Farmacologiche Mario Negri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Laboratory of Immunology and Genetics of Rare Diseases, Bergamo, Italy.
¹² Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France; Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders », Créteil, France.
¹³ Department of Nephrology, Hospital Universitario 12 de Octubre, Complutense University Madrid, Madrid, Spain.
¹⁴ Department of Obstetrics and Gynaecology, Institut d'Investigació Biomèdica Sant Pau - IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Madrid, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), Instituto de Salud Carlos III, Madrid, Spain.
¹⁵ Department of Obstetrics and Gynecology, University of Turin, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy.
¹⁶ Nephrology, Moscow City Hospital n.a. Sergey Petrovich Botkin, Moscow, Russian Federation; Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
¹⁷ Centro de Nefrologia e Dialise, Hospital Sirio-Libanes, São Paulo, Brazil.
¹⁸ Department of Women's Health, Barts Health NHS Trust, London, UK.
¹⁹ Clinical Nutrition Unit, S. Anna Hospital, Città della Salute e della Scienza, Turin, Italy.
²⁰ Central Northern Adelaide Renal and Transplantation Service (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
²¹ Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Cochin Hospital, Université Paris Cité, Paris, France; Unité de l'Institut national de la santé et de la recherche médicale (INSERM) Unité 1153, Center for Epidemiology and Statistics (CRESS), Paris, France.
²² Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
²³ Pathology Department, Hospital General de México Dr Eduardo Liceaga, México City, México.
²⁴ Paris University, Paris, France; Renal Division, Georges Pompidou European Hospital, Paris, France.
²⁵ Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
²⁶ Imperial Lupus Centre, Department of Medicine, Imperial College London, London, UK; Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, London, UK.
²⁷ Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, Paris, France; Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France.
²⁸ Independent Researcher, Milano, Italy.
²⁹ Division of Nephrology, Columbia University Medical Center and the New York Presbyterian Hospital, New York, New York, USA.
³⁰ Maternité Port-Royal, Fédération Hospitalo-Universitaire Prématurité (FHU PREMA), Assistance Publique des Hôpitaux de Paris AP-HP, Hôpital Cochin, AP-HP, Paris, France; Centre-Université de Paris, Université de Paris, Paris, France.
³¹ Department of Nephrology, Centre Hospitalier du Mans, Le Mans, France. Electronic address: gbpiccoli@yahoo.it.

PMID: 36481180
DOI: 10.1016/j.kint.2022.10.029

Abstract

Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.

Keywords: fetal complications; glomerular diseases; immunosuppressive drugs; kidney biopsy; pregnancy.

Publication types

Review

MeSH terms

Clinical Decision-Making
Female
Humans
Kidney
Pregnancy
Pregnancy Complications* / diagnosis
Pregnancy Complications* / etiology
Pregnancy Complications* / therapy
Pregnancy Outcome
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / therapy
Uncertainty