Reassuring pregnancy outcomes in women with mild COL4A3-5-related disease (Alport syndrome) and genetic type of disease can aid personalized counseling.

Autor:	Gosselink ME; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: m.e.gosselink-4@umcutrecht.nl., Snoek R; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands., Cerkauskaite-Kerpauskiene A; Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania., van Bakel SPJ; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands., Vollenberg R; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands., Groen H; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands., Cerkauskiene R; Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania., Miglinas M; Clinic of Gastroenterology, Nephro-Urology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania., Attini R; Department of Obstetrics and Gynecology SC2U, Città della Salute e della Scienza, Sant'Anna Hospital, Turin, Italy., Tory K; MTA-SE Lendulet Nephrogenetic Laboratory, Pediatric Center, Semmelweis University, Budapest, Hungary., Claes KJ; Department of Nephrology, University Hospital Leuven, Leuven, Belgium., van Calsteren K; Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium., Servais A; Department of Nephrology and Transplantation, Necker Enfants Maladies University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France., de Jong MFC; Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands., Gillion V; Department of Nephrology, Cliniques Universitaires Saint-Luc (Université Catholique de Louvain), Brussels, Belgium., Vogt L; Section Nephrology, Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands., Mastrangelo A; Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Furlano M; Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau Universitat Autònoma de Barcelona, RICORS2040 (Kidney Disease), Barcelona, Spain., Torra R; Department of Nephrology, Inherited Kidney Diseases, Fundació Puigvert, Institut d'Investigacions Biomèdiques Sant Pau Universitat Autònoma de Barcelona, RICORS2040 (Kidney Disease), Barcelona, Spain., Bramham K; Department of Women and Children's Health, King's College London, London, UK., Wiles K; Department of Women and Children, Barts National Health Service Trust and Queen Mary University of London, London, UK., Ralston ER; Department of Women and Children's Health, King's College London, London, UK., Hall M; Department of Nephrology, Nottingham University Hospitals, Nottingham, UK., Liu L; Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, Toronto, Ontario, Canada., Hladunewich MA; Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty Faculty of Medicine, Toronto, Ontario, Canada., Lely AT; Department of Obstetrics, University Medical Center Utrecht, Utrecht, the Netherlands., van Eerde AM; Department of Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	Kidney international [Kidney Int] 2024 May; Vol. 105 (5), pp. 1088-1099. Date of Electronic Publication: 2024 Feb 19.
DOI:	10.1016/j.kint.2024.01.034
Abstrakt:	Individualized pre-pregnancy counseling and antenatal care for women with chronic kidney disease (CKD) require disease-specific data. Here, we investigated pregnancy outcomes and long-term kidney function in women with COL4A3-5 related disease (Alport Syndrome, (AS)) in a large multicenter cohort. The ALPART-network (mAternaL and fetal PregnAncy outcomes of women with AlpoRT syndrome), an international collaboration of 17 centers, retrospectively investigated COL4A3-5 related disease pregnancies after the 20th week. Outcomes were stratified per inheritance pattern (X-Linked AS (XLAS)), Autosomal Dominant AS (ADAS), or Autosomal Recessive AS (ARAS)). The influence of pregnancy on estimated glomerular filtration rate (eGFR)-slope was assessed in 192 pregnancies encompassing 116 women (121 with XLAS, 47 with ADAS, and 12 with ARAS). Median eGFR pre-pregnancy was over 90ml/min/1.73m 2 . Neonatal outcomes were favorable: 100% live births, median gestational age 39.0 weeks and mean birth weight 3135 grams. Gestational hypertension occurred during 23% of pregnancies (reference: 'general' CKD G1-G2 pregnancies incidence is 4-20%) and preeclampsia in 20%. The mean eGFR declined after pregnancy but remained within normal range (over 90ml/min/1.73m 2 ). Pregnancy did not significantly affect eGFR-slope (pre-pregnancy β=-1.030, post-pregnancy β=-1.349). ARAS-pregnancies demonstrated less favorable outcomes (early preterm birth incidence 3/11 (27%)). ARAS was a significant independent predictor for lower birth weight and shorter duration of pregnancy, next to the classic predictors (pre-pregnancy kidney function, proteinuria, and chronic hypertension) though missing proteinuria values and the small ARAS-sample hindered analysis. This is the largest study to date on AS and pregnancy with reassuring results for mild AS, though inheritance patterns could be considered in counseling next to classic risk factors. Thus, our findings support personalized reproductive care and highlight the importance of investigating kidney disease-specific pregnancy outcomes. (Copyright © 2024 International Society of Nephrology. All rights reserved.)
Databáze:	MEDLINE
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