Enliven: Nephrology and Renal Studies

Background:
Whether the long-term prognosis of IgA nephropathy is influenced by pregnancy is controversial.

Study Design:
A single center, prospective observational study.

Setting & Participants:
Twenty-five pregnant women with biopsy-proven, IgA nephropathy were enrolled in this study between January 1, 1995, and December 31, 2002 and were followed up for 10 years.

Outcome & Measures:
Rate of change in estimated glomerular filtration rate (eGFR), changes in proteinuria and new-onset hypertension were recorded.

Results:
Mean levels of serum creatinine, eGFR and proteinuria at delivery were: 0.78 +_ 0.29 mg/dL, 98.3 +_ 32.3 mL/min/1.73 m2 and 0.30 +_ 0.19 g/24 h, respectively (all patients). During 10 years’ follow-up, eight patients underwent a second pregnancy. The remaining women did not show any significant changes in eGFR and proteinuria, except for one case, during 10 years’ follow-up. In contrast, except for one out of the eight patients, eGFR levels gradually decreased after the second pregnancy (P < 0.01), accompanied by worsening proteinuria (P < 0.01); one patient developed end-stage renal disease. There were no significant differences in levels of eGFR, proteinuria and blood pressure between women with one or two pregnancies at the baseline of the first delivery. New-onset hypertension was observed in four women who became pregnant twice, where eGFR was reduced to less than 45 mL/min/1.73 m².

Conclusion:
A second pregnancy may be a risk factor for worsening renal function in women with IgA nephropathy, although one pregnancy does not jeopardize a prognosis.