Author: Leo
Keywords: glomerular disease | pregnancy
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Glomerular disease, especially lupus nephritis, is a common disease in women of childbearing age. This article systematically reviewed the diagnosis and treatment of glomerular diseases in pregnant women.
Key words: glomerular disease | pregnancy
treatment
Commonly used drug safety
Should not use drugs
Mycophenolate mofetil (MMF) was associated with a high incidence of spontaneous abortion (45% [95% CI: 29-66]) and was highly teratogenic. Birth defects include cleft lip and cleft palate, lack of ear canal, orbital distance widening and small ear deformity. Women who use MMF should adjust the drug (usually azathioprine) 3 months before pregnancy.
Cyclophosphamide and chlorambucil can also be teratogenic, and increased risk of miscarriage, pregnancy should be avoided.
Hypertension treatment
Hypertension is a common complication of primary glomerular disease, but the target blood pressure during pregnancy is not clear. Terminal organ damage in women, including CKD, the American Society of Obstetrics and Gynecology Pregnancy Hypertension Working Group recommended blood pressure control target <140/90 mmHg.
Methadopa higher safety, low birth weight, preeclampsia, premature birth and neonatal hospitalization rate is low. But also has some limitations, such as the role of short time. Long-term nifedipine and pullerolol is also a first-line treatment, higher safety. Other beta-blockers, especially atenolol, are associated with fetal growth restriction.
Nephrotic syndrome
Primary glomerular disease can cause nephrotic syndrome, clinical features of edema, hypoproteinemia, hypercoagulable state and hyperlipidemia. Peripheral edema is a common symptom of normal women during pregnancy, nephrotic syndrome patients, edema can be aggravated. Conservative treatments include elastic socks, avoiding long standing and high sodium diets. Conservative treatment ineffective severe edema can use loop diuretics and give albumin infusion.
Severe hypoproteinemia (albumin <25 g / L) nephrotic syndrome and increased risk of venous thromboembolic disease. Severe proteinuria and serum albumin <20-25 g / L of women during pregnancy should be thrombectomy treatment, combined with other risk factors (obesity, bed rest, membranous nephropathy) need to consider anticoagulant therapy.
Hyperlipidemia is also a common symptom of nephrotic syndrome, and lipid-lowering drugs statins may cause fetal malformations. Fentanyl, ezetimibe and niacin in pregnancy is still controversial. Because there is no safe for pregnancy-related lipid-lowering drugs, pregnancy-related nephrotic syndrome-related hyperlipidemia is usually not treated.
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