The effects of pregnancy on the progression of maternal glomerular disease

Marques, Luiz Paulo José; Salla, Lívia Menezes; Rioja, Lilimar da Silveira; Rocco, Regina; Madeira, Eugênio Pacelle Queiroz; Vieira, Lygia Maria Soares Fernandes

doi:10.1590/2175-8239-JBN-2024-0205en

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Braz. J. Nephrol. 47 (4) • Oct-Dec 2025 • https://doi.org/10.1590/2175-8239-JBN-2024-0205en linkcopy

The effects of pregnancy on the progression of maternal glomerular disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Although most women with underlying glomerular diseases (GD) are of childbearing age, there is limited information on how pregnancy affects these conditions and maternal outcomes.

Methods: We carried out a single-center retrospective cohort study involving 44 planned pregnancies in 38 patients with biopsy-proven GD. Patients were divided into three groups based on their pre-conception CKD-KDIGO classification: I) Stage 1–2: 27 pregnancies, II) Stage 3a–3b: 11 pregnancies, and III) Stage 4–5: 6 pregnancies. Clinical data included age, chronic hypertension (CH), serum creatinine, preeclampsia (PE), and proteinuria. We considered CH, CKD stage before pregnancy, and PE and nephrotic proteinuria (NPu) during pregnancy as risk factors for maternal GD progression.

Results: We found that 8 women progressed to ESRD and began hemodialysis during pregnancy: 2 (7.8%) in Group I, 1 (9.0%) in Group II, and 5 (83.3%) in Group III. In the remaining 36 pregnancies, we observed a significant GFR loss (p < 0.0001) one year after pregnancy, and GFR loss was greater in group II than in I (p < 0.013). Low GFR rates before pregnancy and PE during pregnancy (p = 0.001) directly impacted GFR loss. We also observed a high incidence (63.6%) of adverse fetal outcomes.

Conclusion: Although pregnancy is possible for women with GD, the impact of pregnancy in maternal GD continues after delivery. Having GD increases the risks of adverse pregnancy outcomes. The progression of GD is directly linked to the CKD stage before pregnancy and PE during pregnancy, and women in CKD stages 4–5 have a high risk of progressing to ESRD during gestation.

Keywords:
Renal Insufficiency; Chronic; Glomerular Diseases; Pregnancy; Chronic Hypertension; Proteinuria; Pre-Eclampsia

N	Diseases pre-Pregnancy	Age/Scr CKDEPI-Pre	Age/Scr CKDEPI-Post	Greater Pu in Pregnancy	Fetal Outcome	Maternal Outcome
1	LN IV	29/1.1	HDc	6.1	PM	ESRD
		69.8
2	IgAN	22/0.9	HDc	4.2	PM	ESRD
		92.7
3	LN IV/CH	26/1.2	27/1.4	3.6	PM	PE
		64.0	52.9
4	FSGS/CH	31/1.0	33/1.2	3.9	PD/LBW	PE
		77.2	61.3
5	IgAN/CH	30/0.9	32/1.0	4.6	PD/LBW	PE
		88.2	76.8
6	IgAN/CH	22/1.0	23/1.2	2.9	PD/LBW	PE
		81.7	65.2
7	LN II/CH	26/1.0	28/1.1	2.4	NN
		79.7	70.2
8	2nd Preg	29/1.0	30/1.1	1.0	NN
		78.2	69.3
9	FSGS/CH	28/1.2	29/1.3	5.1	PD/LBW
		63.2	57.1
10	MCD	23/0.9	25/1.0	3.2	NN
		92.1	80.2
11	2nd Preg	26/1.0	27/1.1	0.8	NN
		79.7	70.6
12	MN	24/1.0	26/1.0	8.2	NN
		80.7	79.7
13	2nd Preg	26/1.0	27/1.2	1.6	NN
		79.7	63.3
14	MPGN/CH	28/1.1	30/1.2	3.5	NN
		70.2	62.5
15	MN	22/0.9	23/1.1	3.1	PD/LBW
		92.7	72.4
16	2nd Preg	25/1.0	26/1.2	1.8	NN
		80.2	64.0
17	MCD	27/1.0	28/1.1	2.2	NN
		79.2	70.2
18	2nd Preg	31/1.0	33/1.1	3.6	NN
		77.2	68.0
19	LN III/CH	29/0.9	30/1.1	3.1	PD/LBW	PE
		88.7	69.3
20	FSGS/CH	39/1.0	41/1.2	1.8	PD/LBW
		73.5	58.3
21	IgAN	33/0.8	35/0.9	3.7	NN
		99.7	85.5
22	HIVAN/CH	36/1.1	37/1.3	2.4	PD/LBW	PE
		66.8	54.3
23	IgAN	31/0.9	33/0.9	0.7	NN
		87.7	86.6
24	LN IV	24/1.0	25/16	4.4	PM	PE
		80.7	45.6
25	FSGS/CH	35/1.1	37/1.4	2.3	PD/LBW	PE
		67.2	49.7
26	LN V	29/1.0	31/1.1	4.6	PD/LBW
		78.2	68.9
27	RN	32/1.0	34/1.1	0.9	NN
		76.8	67.6

N	Diseases pre-Pregnancy	Age/Scr CKDEPI-Pre	Age/Scr CKDEPI-Post	Greater Pu in Pregnancy	Fetal Outcome	Maternal Outcome
1	FSGS/CH	26 / 1.9	HDc	4.9	PD/LBW	PE/ESRD
		36.9
2	LN V/CH	28/1.7	29/2.2	5.1	PM
		41.6	30.4
3	FSGS/CH	29/1.5	31/1.9	2.1	NN
		48.1	35.8
4	FSGS/CH	38/1.3	39/1.8	5.2	PD/LBW
		54.0	36.3
5	MPGN/CH	23/1.4	24/2.0	3.0	PD/LBW	PE
		54.2	35.1
6	FSGS/CH	32/1.6	33/2.6	4.2	PD/LBW	PE
		43.7	24.2
7	FSGS/CH	24/1.3	26/1.5	2.8	NN
		58.9	49.0
8	2nd Preg	29/1.6	30/2.1	3.0	PD/LBW	PE
		44.5	31.9
9	MN	36/1.3	38/1.7	5.2	NN
		54.7	39.1
10	IgAN/CH	32/1.8	33/3.1	3.4	PM	PE
		37.9	19.6
11	LN V/CH	30/1.3	31/1.9	4.0	PM	PA
		56.7	35,8

N	Diseases pre-Pregnancy	Age/Scr CKDEPI-Pre	Age/Scr CKDEPI-Post	Greater Pu in Pregnancy	Fetal Outcome	Maternal Outcome
1	FSGS/CH	24/2.4	HDc	3.9	PD/LBW	PE/ESRD
		28.0
2	LN IV/CH	19/3.1	HDc	4.2	PM	PA/ESRD
		21.4
3	LN IV/CH	30/2.9	HDc	5.6	PM	PE/ESRD
		21.7
4	AS/CH	25/2.8	HDc	4.0	PD/LBW	ESRD
		23.3
5	FSGS/CH	18/3.2	HDc	5.1	PD/LBW	ESRD
		20.7
6	HIVAN/CH	32/2.4	34/4.0	3.8	PD/LBW	PE
		26.8	14.4

Risk Factor	GFR loss one year after pregnancy with	GFR loss one year after pregnancy without	p
Chronic hypertension	13.8 ± 4.2	12.6 ± 8.5	0.951
Nephrotic Proteinuria	13.6 ± 7.6	13.2 ± 4.8	0.899
Pre-eclampsia	17.0 ± 6.2	11.3 ± 5.1	0.001
Risk Factor	GFR loss one year after pregnancy in CKD Stage 1-2	GFR loss one year after pregnancy in CKD Stage 3a-3b	P
CKD KDIGO classification	12.5 ± 6.8	15.7 ± 3.9	0.013

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Nefrologia Rua Machado Bittencourt, 205 - 5ºandar - conj. 53 - Vila Clementino - CEP:04044-000 - São Paulo SP, Telefones: (11) 5579-1242/5579-6937, Fax (11) 5573-6000 - São Paulo - SP - Brazil
E-mail: bjnephrology@gmail.com

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[T1FN1] Abbeviations – FSGS: focal segmental glomerulosclerosis, LN: lupus nephritis, IgAN: IgA nephropathy, MN: membranous nephropathy, MCD: minimal change disease, MPGN: membranoproliferative glomerulonephritis, HIVAN: HIV associated nephropathy, RN: reflux nephropathy. 2^nd Preg: second pregnancy, CH: chronic hypertension, Pu: proteinuria, HDc: chronic hemodialysis, NN: normal newborn, PM: perinatal mortality, PD: preterm delivery, LBW: low birth weight, PE: preeclampsia, PA: placental abruption. ESRD: end-stage renal disease.