Sehoon Park1, Kyung Don Yoo2, Joong Shin Park3, Joon-Seok Hong4, Seungdon Baek5, Su-Kil Park5, Ho Jun Chin6,7, Ki Young Na6,7, Yunhee Choi8, Dong Ki Kim7,9, Kook-Hwan Oh9, Kwon Wook Joo7,9, Yon Su Kim1,7,9, Hajeong Lee7,9. 1. Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Gyeongsangnam-do, Korea. 3. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea. 4. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea. 5. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 6. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea. 7. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. 8. Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea. 9. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Abstract
Background: Recent studies regarding immunoglobulin A nephropathy (IgAN) suggest no relationship between pregnancy and disease progression, although complicated pregnancies and impaired renal function are closely related. Methods: This study used a propensity-score-matched cohort analysis. Among biopsy-confirmed IgAN women in three hospitals in Korea, those who experienced pregnancy after their diagnosis were included in the study group. Renal outcome was the composite of serum creatinine doubling, estimated glomerular filtration rate (eGFR) halving and events of end-stage renal disease. Pregnancies with preterm birth, low birth weight and pre-eclampsia were defined as complicated. Results: Overall, 59 IgAN women who became pregnant after their diagnosis, and the same number of IgAN women who did not experience pregnancy were included in the control group. Although pregnancy itself did not worsen renal outcomes [adjusted hazard ratio (HR): 1.51; 95% confidence interval (CI) 0.57-4.01; P = 0.41], mothers with complicated pregnancies experienced worse renal prognosis, even after adjustment for baseline and pre-gestational characteristics (adjusted HR: 5.07; 95% CI 1.81-14.22; P = 0.002). Moreover, this relationship was only significant in mothers with decreased renal function (eGFR <60 mL/min/1.73 m2) (adjusted HR: 18.70; 95% CI 1.63-214.40; P = 0.02), baseline hypertension (adjusted HR: 4.17; 95% CI 1.13-15.33; P = 0.03) and overt proteinuria (≥1 g/day) (adjusted HR: 4.21; 95% CI 1.24-14.27; P = 0.02). In contrast, patients who experienced pregnancies without complications showed better renal outcomes than did those without post-biopsy pregnancy (P = 0.01). Conclusion: Obstetric complications in patients with high renal risk, rather than pregnancy itself, are associated with renal progression of IgAN women.
Background: Recent studies regarding immunoglobulin A nephropathy (IgAN) suggest no relationship between pregnancy and disease progression, although complicated pregnancies and impaired renal function are closely related. Methods: This study used a propensity-score-matched cohort analysis. Among biopsy-confirmed IgANwomen in three hospitals in Korea, those who experienced pregnancy after their diagnosis were included in the study group. Renal outcome was the composite of serum creatinine doubling, estimated glomerular filtration rate (eGFR) halving and events of end-stage renal disease. Pregnancies with preterm birth, low birth weight and pre-eclampsia were defined as complicated. Results: Overall, 59 IgANwomen who became pregnant after their diagnosis, and the same number of IgANwomen who did not experience pregnancy were included in the control group. Although pregnancy itself did not worsen renal outcomes [adjusted hazard ratio (HR): 1.51; 95% confidence interval (CI) 0.57-4.01; P = 0.41], mothers with complicated pregnancies experienced worse renal prognosis, even after adjustment for baseline and pre-gestational characteristics (adjusted HR: 5.07; 95% CI 1.81-14.22; P = 0.002). Moreover, this relationship was only significant in mothers with decreased renal function (eGFR <60 mL/min/1.73 m2) (adjusted HR: 18.70; 95% CI 1.63-214.40; P = 0.02), baseline hypertension (adjusted HR: 4.17; 95% CI 1.13-15.33; P = 0.03) and overt proteinuria (≥1 g/day) (adjusted HR: 4.21; 95% CI 1.24-14.27; P = 0.02). In contrast, patients who experienced pregnancies without complications showed better renal outcomes than did those without post-biopsy pregnancy (P = 0.01). Conclusion: Obstetric complications in patients with high renal risk, rather than pregnancy itself, are associated with renal progression of IgANwomen.