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Kidney Week

Abstract: TH-PO743

Maintaining Low Mean Blood Pressure Reduces Severe Adverse Events in Pregnant Women with IgA Nephropathy: A Single-Center Retrospective Study

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Kumakura, Satoshi, Tohoku University, Sendai, Japan
  • Yoshida, Mai, Tohoku University, Sendai, Miyagi, Japan
  • Nagasawa, Tasuku, Tohoku University, Sendai, Miyagi, Japan
  • Okamoto, Koji, Tohoku University, Sendai, Miyagi, Japan
  • Ito, Sadayoshi, Katta Hospital, Shiroishi, Japan
  • Miyazaki, Mariko, Tohoku University, Sendai, Japan
Background

A number of young female patients with IgA nephropathy experience pregnancy because the disease population peaks at adolescent age. The clinical course of IgA nephropathy varies; therefore, not all cases receive treatment and follow-ups. However, the risk of pregnancy outcomes among the females with different disease severity and past treatment is not well-known.

Methods

Patients with IgA nephropathy who underwent perinatal care at our institution for 8 consecutive years were recruited for this study. We collected the clinical data by reviewing medical records of patients. Further, we analyzed the correlation between pregnancy outcomes and baseline characteristics, including age, BMI, eGFR, urinary protein (UP), mean blood pressure (MBP), anti-hypertensive drugs use, and past treatment for IgA nephropathy at the time of referral. We set the occurrence of severe adverse events (SAE) as primary outcome and preterm delivery (PreD), small for gestational age (SGA) infants, and low infant birth weight (LBW) as secondary outcomes. We performed logistic regression analysis for each outcome. According to CKD stages, eGFR and UP were categorized into 5 stages and 3 stages, respectively.

Results

We observed 33 pregnancies of 27 patients. Median age was 31 years, median eGFR was 95.5 ml/min/1.73 m2, and median UP was 0.11 g/gCr. SAE occurred in 9 pregnancies. Age (OR = 1.26, p = 0.021), UP stage (OR = 2.92, p = 0.029), MBP (OR = 1.24, p = 0.01), and past methylprednisolone pulse therapy combined with tonsillectomy (OR = 0.14, p = 0.033) were the candidate predictor according to the univariate analysis. Consequently, MBP (OR = 1.33, p = 0.049) was the only predictor for SAE according to the multivariate analysis. Among PreD, SGA, and LBW, univariate analysis showed statistical significance in baseline characteristics as candidate predictors for SAE. However, multivariate analysis showed no statistical significance among those candidates.

Conclusion

Univariate analysis showed that less proteinuria, lower MBP, and treatment with combined therapy reduce risk of SAE, whereas multivariate analysis showed that MBP is the only predictor for SAE. Our study implies that patients with IgA nephropathy should receive treatments until their blood pressure normalizes before initiating pregnancy.