Jussara Leiko Sato

Pregnancy after renal transplantation – a five-yr single-center experience

Abstract:  Background:  There has been an increase in the number of pregnancies in renal transplant recipients. Our aim was to report our experience with a significant casuistic.

Clinical formulas, mother's opinion and ultrasound in predicting birth weight

CONTEXT AND OBJECTIVE Accurate fetal weight estimation is important for labor and delivery management. So far, there has not been any conclusive evidence to indicate that any technique for fetal weight estimation is superior to any other. Clinical formulas for fetal weight estimation are easy to use but have not been extensively studied in the literature. This study aimed to evaluate the accuracy of clinical formulas for fetal weight estimation compared to maternal and ultrasound estimates. DESIGN AND SETTING Prospective study involving 100 full-term, cephalic, singleton pregnancies delivered within three days of fetal weight estimation. The setting was a tertiary public teaching hospital in São Paulo, Brazil. METHODS Upon admission, the mothers opinion about fetal weight was recorded. Symphyseal-fundal height and abdominal girth were measured and two formulas were used to calculate fetal weight. An ultrasound scan was then performed by a specialist to estimate fetal weight. The four estimates were compared with the birth weight. The accuracy of the estimates was assessed by calculating the percentage that was within 10% of actual birth weight for each method. The chi-squared test was used for comparisons and p < 0.05 was considered significant. RESULTS The birth weight was correctly estimated (+/- 10%) in 59%, 57%, 61%, and 65% of the cases using the mothers estimate, two clinical formulas, and ultrasound estimate, respectively. The accuracy of the four methods did not differ significantly. CONCLUSION Clinical formulas for fetal weight prediction are as accurate as maternal and ultrasound estimates.

Pregnancy after renal transplantation: an evaluation of the graft function

OBJECTIVES To evaluate pregnancy outcomes and graft function in renal transplant recipients. STUDY DESIGN Thirty-four pregnancies in 31 patients were evaluated. Graft dysfunction was defined as an increase of 0.3mg/dL (215 μmol/L) or more in serum creatinine (SCr) during pregnancy. Twenty-eight patients were also evaluated at one, six and twelve months after delivery to analyze the evolution of the graft function. RESULTS Fifteen patients experienced graft dysfunction during pregnancy, 10 related to preeclampsia, two related to rejection, one related to allograft obstruction and one related to urinary tract infection. One patient did not have an identified cause. In one patient, graft rejection ended in graft loss. The mean SCr level in the first trimester was 0.9 mg/dL (range: 0.5-2.1) among women who did not have graft dysfunction and 1.1mg/dL (range: 0.5-1.9) among patients who had graft dysfunction (P=0.66). The mean SCr level one year after delivery was 1.18 mg/dL in the first group and 1.21 mg/dL in the second group (P=0.74). There was no difference in SCr level from the first trimester of pregnancy to one year after delivery in both groups evaluated (P=0.35 and P=0.13). CONCLUSIONS Although graft dysfunction may occur during pregnancy, it seems to be temporary in the majority of the cases. It is important to emphasize that rejection is still a cause of graft loss during pregnancy.

Chronic kidney disease in pregnancy requiring first-time dialysis

To report on the treatment and outcome of pregnancy in 29 women with chronic kidney disease (CKD), 24 of whom had moderate or severe renal dysfunction.

236. Pregnancy in renal transplant patients: renal function markers and maternal-fetal outcomes

Introduction Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Podocytes are fundamental cells for maintaining the functionality of glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number and results in progressive glomerular dysfunction, causing proteinuria and glomerulosclerosis and ultimately leading to end-stage kidney disease. Assessment of podocyturia and its correlation with other renal parameters could help with the diagnosis and definition of prognosis of the glomerulopathies, thus contributing to risk reduction. Objective To evaluate podocyturia and others renal parameters as functional markers in pregnant women with kidney grafts. Methods In this cross-sectional and prospective study, 43 pregnant women with kidney grafts had their Mid-stream urine samples collected to determine proteinuria, including retinol-binding protein (enzyme immunoassay using monoclonalantibodies), albumin/creatinine ratio (immunoturbidimetry), protein/creatinine ratio (the alkaline picrate colorimetric method), and podocyturia (indirect immunofluorescence). Results 43 women who got pregnant after renal transplantation were included. Podocyturia was not significantly correlated with other renal function markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P  Conclusion Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Proteinuria (or more specifically, urinary protein/creatinine ratio) and albumin/creatinine ratio has also used as a marker of CKD progression. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant. Using these markers to assess renal function during pregnancy may be clinically useful for early diagnosis and follow-up of glomerular injury, eventually preeclampsia. It may be also associated to its severity or activity.

Pregnancy after kidney transplantation: high rates of maternal complications

INTRODUCTION Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. OBJECTIVE To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications. METHODS Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. RESULTS There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001). CONCLUSION Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Podocitúria em gestantes hipertensas crônicas pode predizer dano renal

PURPOSE To evaluate the presence of podocyturia in chronic hypertensive pregnant women in the third trimester of pregnancy and its possible association with renal disease. METHODS This was an observational study of a convenience sample of 38 chronic hypertensive pregnant women. The podocytes were labeled by the indirect immunofluorescence technique with anti-podocin and diamidino-phenylindole (DAPI). The count was made on 30 random fields analyzed and corrected according to urinary creatinine (podocytes/mg creatinine). The patients were assigned to two groups: NG (normal glomerular function), up to 100 podocytes, and GP (probable glomerulopathy), more than 100 podocytes. Urinary creatinine was measured by the alkaline picrate method. The variables analyzed were body mass index, gestational age, and systolic and diastolic blood pressure at the time of sample collection. Data were analyzed using the SPSS - version 16.0 (IBM - USA). Statistical analysis was performed by the χ2 test, and significant differences were considered when p<0.05. RESULTS The median podocyte count was 20.3 (0.0-98.1) for group GN, and 176.9 (109.1-490.6) for GP. The mean body mass index was 30.2 kg/m2 (SD=5.6), mean gestational age was 35.1 weeks (SD=2.5), median systolic blood pressure was 130.0 mmHg (100.0-160.0) and median diastolic blood pressure was 80.0 mmHg (60.0-110.0). There was no significant correlation between podocyturia and body mass index (p=0.305), gestational age (p=0.392), systolic blood pressure (p=0.540) or diastolic blood pressure (p=0.540). CONCLUSIONS In this study, there was no podocyturia pattern consistent with the presence of active renal disease, although some of the women studied (15.8%) exhibited a significant loss. We believe that it is premature to recommend the inclusion of the determination of podocyturia in routine prenatal clinical practice in chronically hypertensive pregnant women.

PP148. Is there podocyturia in pregnant women with chronic hypertension? (Preliminary results).

later age of her reproductive cycle has be a phenomenon around the world. Epidemiology data show frequent increase of clinical complications in direct proportion in advanced age motherhood, hypertensive disturbances being more prevalent. Objectives: Analyse the prevalence of hypertensive syndromes in pre-determined age groups at Hospital Guilherme Alvaro in Santos, Sao Paulo, Brazil showing the different segments in each one. Methods: From data collected in the outpatient department of Hospital Guilherme Alvaro of High Risk Pre-natal between 04/06/2008 and 30/05/2011, a prevalence transversal study was carried out where data were obtained from 628 patients aged between 16 and 46 years. Procedures of homogeny analysts were set out, always collecting data such as age and disorder for high risk gestation. According to age, patients were divided into groups: precocious (up to 19 years old), middle age (between 20 and 34) and late pregnancies (over 35). Results: In the precocious pregnancies, clinical illnesses/ no hypertension (31%) were observed in first place, 25% (8) twin pregnancy in second place, 19% (6) showed hypertensive disturbances. Concerning pregnancies between 20 and 34 years old, 36% (144 patients) showed hypertensive syndromes, 23% (92 patients) showed endocrine disturbances, 22% (90 patients) showed clinical illnesses/no hypertension, and 9% twin pregnancy. Regarding late pregnancies, the most frequent disturbance was isolated hypertensive syndromes: 44% (88 patients) in first place, only endocrine disturbances, 24% (47 patients) in second place followed by association between hypertensive syndromes and endocrinopathy with 13% (26 patients). Conclusion: About precocious pregnancies, greater prevalence showed clinical illnesses/no hypertension, whereas middle age and late pregnancies showed greater hypertensive syndrome prevalence, results, which are compatible with other studies, have been observed that due to advance of age, hypertensive syndromes aremore frequent. For late pregnancies, the prevalence of clinical illnesses/no hypertension was a lower percentage regarding the other two groups: precocious pregnancies (31% = 10 women), middle age pregnancies (22% = 90 women), and late pregnancies (2% = 7 women). Considering the fact that the occurrence of pregnancy is more and more late in life, it can be concluded that the professionals must be prepared to attend pregnancies on women with hypertensive disturbances and their eventual complications.