Pregnancy in glomerulonephritic patients with decreased renal function

Objective: A study was designed to evaluate fetal outcome of pregnancy and subsequent renal outcome in women with chronic glomerulonephritis who had moderately decreased renal function prior to conception. Methods: Data were analyzed from 15 pregnancies in 12 women whose glomerular filtration rate (GFR) was below 50 mL/min (GFR 42 +/- 10 mL/min). The results were compared with those of 166 chronic glomerulonephritic patients whose average preconception GFR was 83 +/- 13 mL/min. Renal functions during the 3-year follow-up period were compared between the 12 pregnant and 12 nonpregnant nephritic patients whose ages and GFRs were matched at the start of observation. Results-Obstetrical Outcomes: There were five normal deliveries, six complicated deliveries with a live infant, and four perinatal deaths. The average birth weight was 2115 +/- 753 g. This compared poorly with the obstetrical outcomes in women with mild renal impairment, in which the rate of normal delivery was 66% (P < 0.01) and of perinatal death was 6% (P < 0.01). Renal function was evaluated at 3 years after delivery. In four, function was stable, while marked disease progression had occurred in eight, six of whom were undergoing hemodialysis. In six pregnant women, the slopes obtained by plotting the reciprocal of serum creatinine versus time were far steeper than those of nonpregnant control nephritics. Conclusions: Although women with moderately decreased renal function still have a high incidence of live births, many of their pregnancies are complicated, and in half of them deterioration of their underlying renal disorder appears to be hastened.