Pregnancy outcomes with pre-existing renal disease in a dedicate MDT clinic.

Dr Bethany Wildridge (presenting), Mr Ramesh Ganapathy, Miss Antoinette Johnson, Dr David Makanjuola, Professor Hassan Shehata, Dr Christina Bell, Dr Lucy Mountford. 

Objective: 

To evaluate the impact of a joint Obstetric and Renal clinic on obstetric outcomes in patients with high-risk pregnancies due to Chronic Kidney Disease (CKD)

Design: 

We performed a retrospective cohort study of patients who attended the clinic between 2005 and December 2021. There were 74 patients included for analysis.

Characteristics: 

62 conceptions

55 live births

Mean maternal age 32 years old

Average parity of 2

Methods: 

• St Helier's hospital is a regional tertiary unit for Renal Medicine and the South West London and Surrey Heartlands Maternal Medicine Network.
• The data included all women with pre-existing renal conditions who were cared for in a dedicated renal and obstetric clinic comprising maternal medicine consultants and midwives with a consultant renal physician. Datasets were extracted from hospital notes, the renal database, clinic data and maternity electronic health records.
• Data analysed included demographics, pre-existing renal condition, chronic hypertension, biochemical parameters related to the renal condition (creatinine, estimated GFR [eGFR], urine total protein to creatinine ratio) and parity; pregnancy outcomes included miscarriages, gestation at birth, mode of delivery, post-partum haemorrhage (PPH), pregnancy loss, birth weight and neonatal admission.
• The local pregnant population’s outcomes were included for comparison with those of the joint renal-obstetric clinic.

Lupus Nephritis Patients (n=6)

4 delivered at term

3 had pre-eclampsia

2 had PPH

4 eGFRs returned to baseline levels within 12 months

IgA neprhopathy Patients (n=5)

4 delivered at term

2 had pre-eclampsia

5 delivered by Caesarean section (CS).

All 5 eGFRs returned to baseline within 12 months

Polycystic Kidney Disease Patients (n=6)

2 had pre-eclampsia

5 had vaginal deliveries at term

6 had pre-existing hypertension

Miscarriages (n=5)

2 of whom have IV Lupus

Other diagnoses include Duplex Kidney with re-implanted ureter, APLS and hypertensive nephropathy

1 late miscarriage at 22 weeks

Creatinine fall < 10 % (n=5)

4 pre-term births

Transplant patients (n=12)

8 pregnancies

6 live births, all at term

1 developed pre-eclampsia

Conclusion:

• CKD patients, specifically those with lupus nephritis, PKD, and IgA nephropathy demonstrated a higher incidence of adverse pregnancy outcomes as compared with our local pregnant population.
• The transplant patients had fewer adverse pregnancy outcomes than the CKD population.
• Our findings reflect those of larger studies of CKD patients, aligns with current evidence and supports the role of combined renal/obstetric clinics.
• More research and larger scale studies are needed into specific CKD conditions and their outcomes.