Pregnancy complications and gestational proteinuria and serum creatinine dynamics in women with chronic glomerulonephritis and chronic tubulointerstitial kidney diseases
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.553
Abstract
Introduction. Women with chronic kidney disease (CKD) have an increased incidence of pregnancy complications, but few comparative studies on features of pregnancy course during chronic glomerulonephritis (CGN) and chronic tubulointerstitial kidney disease (CTID) are available.
Aim: comparison the frequency of pregnancy complications, proteinuria (PU) and serum creatinine dynamics in patients with CGN and CTID.
Materials and Methods. We conducted an observational single-centre study enrolling 128 pregnant women with CGN (135 deliveries) and 138 with CTID (145 deliveries) by assessing the incidence of complications, diurnal PU, serum creatinine level starting from early gestation to delivery every 4–6 weeks.
Results. Favourable pregnancy outcome was observed in 94.8 % of patients with CGN and in 95.7 % with CTID. The incidence of preeclampsia (PE), placental insufficiency, acute kidney injury, and preterm delivery showed no not inter-group differences, but arterial hypertension, PU > 1.0 g/day were more common in CGN, whereas in CTID – urinary tract infections. During pregnancy, PU increased in both groups, and only in CGN in patients with PE early pregnancy PU was significantly higher than in those without PE. Both groups showed similar serum creatinine dynamics: decrease starting from early pregnancy stages, stabilization in the middle of pregnancy followed by elevation from 28–30 weeks of gestational age until delivery.
Conclusion. High PU level in early pregnancy may help to predict PE in CGN, but not in CTID. In patients with CKD, rise in PU along with serum creatinine increased up to baseline level in late pregnancy, are typically observed and without PE, fetal distress should not be considered as unambiguous indication for early delivery.
About the Authors
E. I. Prokopenko
Vladimirsky Moscow Regional Clinical Research Institute; Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynaecology
Russian Federation
Russian Federation
Elena I. Prokopenko, MD, Dr Sci Med, Prof.
Scopus Author ID: 6603371670
WoS ResearcherID: M-4222-2014
61/2 Shchepkina Str., 129110 Moscow
22-а Pokrovka Str., 110000 Moscow
I. G. Nikolskaya
Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynaecology
Russian Federation
Russian Federation
Irina G. Nikolskaya, MD, Dr Sci Med.
Scopus Author ID: 57206276951
WoS ResearcherID: JZE-2597-2024
22-а Pokrovka Str., 110000 Moscow
D. V. Gubina
Vladimirsky Moscow Regional Clinical Research Institute
Russian Federation
Russian Federation
Daria V. Gubina, MD
Scopus Author ID: 57288924900
61/2 Shchepkina Str., 129110 Moscow
A. V. Vatazin
Vladimirsky Moscow Regional Clinical Research Institute
Russian Federation
Russian Federation
Andrey V. Vatazin, MD, Dr Sci Med, Prof.
Scopus Author ID: 6604000372
WoS ResearcherID: AAA-8782-2019
61/2 Shchepkina Str., 129110 Moscow
T. S. Kovalenko
Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynaecology
Russian Federation
Russian Federation
Tatyana S. Kovalenko, MD, PhD
Scopus Author ID: 57198060332
WoS ResearcherID: JZT-7128-2024
22-а Pokrovka Str., 110000 Moscow
E. B. Efimkova
Academician Krasnopolsky Moscow Regional Research Institute of Obstetrics and Gynaecology
Russian Federation
Russian Federation
Ekaterina B. Efimkova, MD, PhD
Scopus Author ID: 57221945010
22-а Pokrovka Str., 110000 Moscow
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What is already known about this subject?
► Patients with chronic kidney disease (CKD) have an increased incidence of pregnancy complications compared to healthy women: preeclampsia (PE), intrauterine growth retardation, preterm labor and a need for operative delivery.
► Diurnal proteinuria does not exceed 300 mg level during physiological pregnancy course in healthy women. Proteinuria (PU) greater than 300 mg/day is one of PE signs, but in patients with CKD, pathological PU can be observed even without PE.
► In healthy women and in some patients with CKD, a gestational decrease in serum creatinine level is noted, most prominent in the second trimester of pregnancy.
What are the new findings?
► Among patients with chronic glomerulonephritis (CGN) compared to those suffering from chronic tubulointerstitial kidney diseases (CTID) during pregnancy, the percentage of women with PU > 1.0 g/day and patients with arterial hypertension was significantly higher, whereas percentage of patients with urinary tract infection was lower. The incidence of PE, placental insufficiency, preterm labor and caesarian section did not differ between groups.
► Virtually throughout entire pregnancy in patients with CGN vs. CTID, PU was significantly higher, but serum creatinine level did not differ between groups.
► In pregnant women with CGN who developed PE, early pregnancy PU was significantly elevated compared to patients without PE. However, in patients with CTID, early pregnancy PU did not differ between the preeclamptic and non-preeclamptic subgroups.
► In both patients with CGN and women with CTID, an increase in PU was observed from early gestation until the end of pregnancy (excepting stabilization period at 26–32 weeks of gestational age), whereas serum creatinine level decreased by 11–13 weeks, then stabilized, and after 26–28 weeks increased until delivery.
How might it impact on clinical practice in the foreseeable future?
► The presence of prominent PU in early pregnancy and its persistence throughout gestation in patients with CGN will assist in assessing an increased risk of superimposed PE. In patients with CTID, lack of PU in early pregnancy does not allow predicting the lack of superimposed PE.
► Interpretation of moderately increased serum creatinine level later than gestational age of 6 weeks as physiological changes (in the absence of major signs of РЕ and fetal distress) will allow avoid unjustified preterm delivery in patients with CKD.
Review
For citations:
Prokopenko E.I., Nikolskaya I.G., Gubina D.V., Vatazin A.V., Kovalenko T.S., Efimkova E.B. Pregnancy complications and gestational proteinuria and serum creatinine dynamics in women with chronic glomerulonephritis and chronic tubulointerstitial kidney diseases. Obstetrics, Gynecology and Reproduction. 2025;19(2):201-215. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.553
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