Successful Pregnancy with Terminal Renal Failure: Fiction or Reality (on the Example of Clinical Observation)

195 million women on Earth suffer from chronic kidney disease — some of them are planning to become mothers. Even in absolutely healthy women, pregnancy is fraught with risks. These risks increase when it comes to kidney pathology. It is known that pregnancy in women with kidney diseases, even with preserved renal function, is accompanied by serious problems for both the mother and the fetus. We present a clinical observation of a 23-year-old patient with terminal renal insufficiency who successfully carried out the pregnancy. The patient’s polymorbid condition (chronic kidney disease, ulcerative colitis, anemia, etc.) required complex therapy and an interdisciplinary approach, which was implemented from the first days of the woman’s observation. The highly professional work of a team of specialists (nephrologists, resuscitators, obstetricians-gynecologists, gastroenterologists, infectious disease specialists, functional diagnostics doctors, urologists, etc.) determined the successful outcome of this observation. The article focuses on the factors aggravating this observation, as well as determining, on the contrary, a favorable outcome. 

1. Kozlovskaya N.L., Korotchaeva Yu.V., Demyanova K.A. at al. Features of pregnancy of a patient with a chronic kidney stage. Nephrology. 2019; 23(2): 109-116. https://doi.org/10.24884/1561-6274-2019-232-109-116 [in Russian].

2. Piccoli GB, Attini R, Vasario E et al. Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol. 2010 May; 5(5): 844-55. doi: 10.2215/CJN.07911109.

3. Confortini P., Galanti G., Ancona G. et al. Full term pregnancy and successful delivery in a patient on chronic haemodialysis. Proc Eur Dial Transplant Assoc 1971; 8: 74-80.

4. Oliverio AL, Hladunewich MA. End-Stage Kidney Disease and Dialysis in Pregnancy. Adv Chronic Kidney Dis. 2020 Nov; 27(6): 477-485. doi: 10.1053/j.ackd.2020.06.001. PMID: 33328064; PMCID: PMC7781109.

5. Shaw J, Katopodis C, Hladunewich MA, et al. Changing dalysis modality during pregnancy: a case report. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis. 2018; 38(6) : 456–458. doi: 10.3747/pdi.2018.00054. PMID: 30413638.

6. Jesudason S, Grace BS, McDonald SP. Pregnancy outcomes according to dialysis commencing before or after conception in women with ESRD. Clinical Journal of the American Society of Nephrology. 2014; 9(1): 143–149. doi: 10.2215/CJN.03560413. Epub 2013 Nov 14. PMID: 24235285; PMCID: PMC3878697.

7. Manisco G, Potì’ M, Maggiulli G, et al. Pregnancy in end-stage renal disease patients on dialysis: how to achieve a successful deliver. Clin Kidney J. 2015; 8(3): 293–299. doi: 10.1093/ckj/sfv016. Epub 2015 Mar 19. PMID: 26034591; PMCID: PMC4440463.

8. Cabiddu G, Mannucci C, Fois A, et al. Pre-eclampsia is a valuable opportunity to diagnose chronic kidney disease: a multicentre study. Nephrology. Dialysis. Transplantation. 2021; 37(8):1488-1498. doi: 10.1093/ndt/gfab225. PMID: 34338783; PMCID: PMC9317168.

9. Tangren J.S., Wan Md Adnan W.A.H., Powe C.E., et al. Risk of Preeclampsia and Pregnancy Complications in Women with a History of Acute Kidney Injury. Hypertension. 2018; 72: 451–459. doi: 10.1161/HYPERTENSIONAHA.118.11161

10. Ribeiro CI, Silva N. Pregnancy and dialysis. J Bras Nefrol. 2020 Jul-Sep; 42(3): 349-356. doi: 10.1590/2175-8239-JBN-2020-0028. PMID: 32776086; PMCID: PMC7657054.

11. Shilov E.M., Smirnova A.V., Kozlovskaya N.L. Nephrology. Clinical recommendations. GEOTAR-Media, 2019; 856 p [in Russian].

12. Nikolskaya I.G., Novikova S.V., Barinova I.V. Chronic kidney disease and pregnancy: etiology, pathogenesis, classification, clinical picture, perinatal complications. Russian Obstetrician-Gynecologist Bulletin. 2012; 12(5): 21-30 [in Russian].

13. He Y, Liu J, Cai Q et al. The pregnancy outcomes in patients with stage 3-4 chronic kidney disease and the effects of pregnancy in the long-term kidney function. J Nephrol 2018 Dec; 31(6): 953- 960. https://doi.org/10.1007/s40620-018-0509-z. Epub 2018 Jul 19

14. Shahir AK, Briggs N, Katsoulis J, et al. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology (Carlton) 2013; 18(4): 276–284. doi: 10.1111/nep.12044. PMID: 23441694.

15. Shah S, Christianson AL, Meganathan K et al. Differences and factors associated with pregnancy in ESKD. Patients on dialysis in the United States. Journal of the American Society of Nephrology. 2019.

16. Wiles K, Chappell L, Clark K, et al. Clinical practice guideline on pregnancy and renal disease. BMC Nephrol. 2019; 20 (1): 401. doi: 10.1186/s12882-019-1560-2. PMID: 31672135; PMCID: PMC6822421.

17. Villa G, Montagna G, Segagni S. La gravidanza in dialisi cronica: esperienza personale e revisione della letteratura [Pregnancy in chronic dialysis. A case report and a review of the literature]. G Ital Nefrol. 2007; 24(2): 132-40. Italian. PMID: 17458828.

18. Haase M, Morgera S, Bamberg CH, et al. A Systematic approachto managing pregnant dialysis patients—the importance of an intensified haemodiafiltration protocol. Nephrol Dial Trans-plant. 2005; 20(11): 2537-42. doi: 10.1093/ndt/gfi044. Epub 2005 Aug 22. PMID: 16115858.

19. Ribeiro CI, Silva N. Pregnancy and dialysis. J Bras Nefrol. 2020 JulSep;42(3):349-356. doi: 10.1590/2175-8239-JBN-2020-0028. PMID: 32776086; PMCID: PMC7657054

20. Prokopenko E.I., Nikolskaya I.G., Rybakova O.B. et al. Successful pregnancy in a patient on programmed hemodialysis awaiting kidney transplantation. Almanac of Clinical Medicine. 2017; 45(7): 599-604. DOI 10.18786/2072-0505-2017-45-7-599-604 [in Russian].

21. Nikolskaya I.G., Prokopenko E.I., Kozlovskaya N.L. et al. Pregnancy with chronic kidney disease. Planning of gestation and recovery in schemes and algorithms. Media Bureau Status Presence, 2022: 188 р. [in Russian].

22. Nikolskaya I.G., Prokopenko E.I., Novikova S.V. Complications and outcomes of pregnancy in chronic renal failure. Almanac of Clinical Medicine. 2015; (37): 52-69. [in Russian].