A multicenter cohort study of histologic findings and long-term outcomes of kidney disease in women who have been pregnant

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Title: A multicenter cohort study of histologic findings and long-term outcomes of kidney disease in women who have been pregnant
Authors: Webster, P
Webster, LM
Cook, HT
Horsfield, C
Seed, PT
Vaz, R
Santos, C
Lydon, I
Homsy, M
Lightstone, L
Bramham, K
Item Type: Journal Article
Abstract: BACKGROUND AND OBJECTIVES: For many women pregnancy is the first contact with health services, thus providing an opportunity to identify renal disease. This study compares causes and long-term renal outcomes of biopsy-proven renal disease identified during pregnancy or within 1 year postpartum, with nonpregnant women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Native renal biopsies (1997-2012), in women of childbearing age (16 to <50 years), from 21 hospitals were studied. The pregnancy-related diagnosis group included those women with abnormal urinalysis/raised creatinine identified during pregnancy or within 1 year postpartum. Pregnancy-related and control biopsies were matched for age and ethnicity (black versus nonblack). RESULTS: One hundred and seventy-three pregnancy-related biopsies (19 antenatal, 154 postpregnancy) were identified and matched with 1000 controls. FSGS was more common in pregnancy-related biopsies (32.4%) than controls (9.7%) (P<0.001) but there were no differences in Columbia classification. Women with a pregnancy-related diagnosis were younger (32.1 versus 34.2 years; P=0.004) and more likely to be black (26.0% versus 13.3%; P<0.001) than controls, although there were no differences in ethnicities in women with FSGS. The pregnancy-related group (excluding antenatal biopsies) was more likely to have a decline in Chronic Kidney Disease Epidemiology Collaboration eGFR in the follow-up period than the control group (odds ratio, 1.67; 95% confidence interval, 1.03 to 2.71; P=0.04), and this decline appeared to be more rapid (-1.33 versus -0.56 ml/min per 1.73 m(2) per year, respectively; P=0.045). However, there were no differences between groups in those who required RRT or who died. CONCLUSIONS: Pregnancy is an opportunity to detect kidney disease. FSGS is more common in women who have been pregnant than in controls, and disease identified in pregnancy or within 1 year postpartum is more likely to show a subsequent decline in renal function. Further work is required to determine whether pregnancy initiates, exacerbates, or reveals renal disease.
Issue Date: 9-Dec-2016
Date of Acceptance: 31-Oct-2016
ISSN: 1555-905X
Publisher: American Society of Nephrology
Start Page: 408
End Page: 416
Journal / Book Title: Clinical Journal of the American Society of Nephrology
Volume: 12
Issue: 3
Copyright Statement: © 2016 by the American Society of Nephrology
Keywords: biopsy
focal segmental glomerulosclerosis
follow-up studies
glomerulosclerosis, focal segmental
odds ratio
postpartum period
renal biopsy
renal insufficiency, chronic
urinary tract physiological phenomena
Urology & Nephrology
1103 Clinical Sciences
Publication Status: Published
Conference Place: United States
Appears in Collections:Department of Medicine
Faculty of Medicine

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