nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2019-2-213-220nid-265Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESОстрое повреждение почек на фоне хронической болезни почек при беременностиAcute kidney injury in pregnant women with chronic kidney diseaseПрокопенкоЕ. И.ProkopenkoE. I.renalnephron@gmail.comНикольскаяИ. Г.NikolskayaI. G.noemail@neicon.ruПензеваД. В.PenzevaD. V.noemail@neicon.ruШестероЕ. В.ShesteroE. V.noemail@neicon.ruГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian FederationГБУЗ МО Московский областной научно-исследовательский институт акушерства и гинекологииРоссияMoscow Regional Research Institute of Obstetrics and GynecologyRussian Federation201905082024212213220Copyright © Прокопенко Е.И., Никольская И.Г., Пензева Д.В., Шестеро Е.В., 20242024Прокопенко Е.И., Никольская И.Г., Пензева Д.В., Шестеро Е.В.Prokopenko E.I., Nikolskaya I.G., Penzeva D.V., Shestero E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/265

Цель работы: изучить частоту развития, предрасполагающие факторы, причины и исходы ассоциированного с беременностью острого повреждения почек (ОПП) у пациенток с хронической болезнью почек (ХБП). Методы: в исследование включены 305 беременностей у 291 женщин с ХБП стадий 1-4 (средний возраст при наступлении беременности 29,4 [25,8; 32,9] лет, длительность заболевания почек 12,0 [5,0; 21,0] лет). Во время беременности и после родов выполнялось в динамике измерение диуреза, определение уровня креатинина, СКФ в пробе Реберга. Для выявления ОПП использовались критерии KDIGO. Результаты: ОПП на фоне ХБП развилось при 35 из 305 (11,5%) беременностей у 34 (11,7%) из 291 женщин (у одной пациентки ОПП наблюдалось при каждой из двух беременностей). Всего отмечено 37 эпизодов ОПП. Частота ОПП при ХБП С1 составила 1,0%, С2 - 4,3%, С3А - 46,9%, С3Б - 50,0%, С4 - 71,4% (p<0,001). Риск развития ОПП на фоне ХБП при беременности достоверно повышали артериальная гипертензия, нефротическая протеинурия, наличие 3-4 стадии ХБП, анемия, преэклампсия, фетоплацентарная недостаточность, кесарево сечение. Причиной ОПП в большинстве случаев (67,6%) была преэклампсия. В группе ОПП по сравнению с пациентками без ОПП были достоверно меньше срок родоразрешения - 35,3 [32,6; 37,1] против 38,3 [37,3; 39,6] нед., p<0,001, и ниже - перцентильная масса ребенка при рождении - 29,8 [12,4; 51,5] против 44,5 [21,1; 66,6], p=0,014. В дальнейшем достигли ХБП пятой стадии и начали диализное лечение 35,3% пациенток, перенесших ОПП на фоне ХБП при беременности, и только 2,3% в группе без ОПП (p<0,001). Заключение: ОПП на фоне ХБП нередко встречается в период гестации и оказывает негативное влияние на исходы беременности для матери и плода.

Aim: to study the incidence, predisposing factors, causes and outcomes of pregnancy-related acute kidney injury (AKI) in patients with chronic kidney disease (CKD). Methods: The study included 305 pregnancies in 291 women with CKD stages 1-4 (mean age 29.4 [25.8; 32.9] years; the duration of CKD 12.0 [5.0, 21.0] years). During pregnancy and after childbirth diuresis, creatinine level, and GFR were studied. The KDIGO criteria were used to identify AKI. Results: AKI on CKD developed in 35 of 305 (11.5%) pregnancies in 34 (11.7%) of 291 women (one patient had AKI in each of two pregnancies). A total of 37 episodes of AKI were recorded. The incidence of AKI on CKD stage 1 was 1.0%, stage 2 - 4.3%, stage 3A - 46.9%, stage 3B - 50.0%, and stage 4 - 71.4% (p<0.001). The risk of AKI on CKD increased with arterial hypertension, nephrotic proteinuria, CKD 3-4 stage, anemia, preeclampsia, placental insufficiency, cesarean section. The main cause of AKI (67.6% cases) was preeclampsia. In the AKI group, compared to pregnancies without AKI, gestational age at delivery and percentile birth weight were less - 35.3 [32.6; 37.1] vs 38.3 [37.3; 39.6] weeks, p<0.001, and 29.8 [12.4; 51.5] vs 44.5 [21.1; 66.6], p=0.014, respectively. In the follow-up, 35.3% of patients who had AKI on CKD during pregnancy progressed to stage 5 CKD and started dialysis, compared with 2.3% in women without AKI (p<0.001). Conclusion: AKI on CKD often occurs during gestation and impact negatively on pregnancy outcomes for the mother and fetus.

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