Kidney disease and reproductive health

IF 28.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Nature Reviews Nephrology Pub Date : 2024-11-05 DOI:10.1038/s41581-024-00901-6
Priscilla A. Smith, Ippokratis Sarris, Katherine Clark, Kate Wiles, Kate Bramham
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Abstract

Understanding the relationship between reproductive health and kidney function is important to provide holistic care for people living with kidney disease. Chronic kidney disease (CKD) has negative impacts on both male and female fertility owing to factors including inflammation, hormonal dysregulation, reduced ovarian reserve, reduced sperm quality and sexual dysfunction. However, pregnancy is achievable for most cisgender women with kidney disease, including kidney transplant recipients and patients on dialysis. CKD in pregnancy is associated with health risks to the mother and child, including increased risk of progression of kidney disease, hypertensive complications of pregnancy, and neonatal complications including fetal growth restriction, preterm birth and stillbirth. However, with appropriate pre-pregnancy counselling, fertility assessment and support, health optimization, and evidence-based antenatal care, the majority of patients will achieve a good outcome. Medication safety should be reviewed before and during pregnancy and lactation, weighing the risk of disease flare against potential adverse effects on the offspring. Important areas for further research include the optimal timing of delivery and the short- and long-term cardiovascular and renal impacts of pregnancy in patients with CKD, as well as long-term kidney and cardiovascular outcomes in their offspring.

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肾病和生殖健康
了解生殖健康与肾功能之间的关系对于为肾病患者提供整体护理非常重要。由于炎症、荷尔蒙失调、卵巢储备功能降低、精子质量下降和性功能障碍等因素,慢性肾脏病(CKD)对男性和女性的生育能力都有负面影响。不过,大多数患有肾病的顺性别女性都可以怀孕,包括肾移植受者和透析患者。妊娠合并慢性肾脏病会给母婴健康带来风险,包括肾脏病恶化、妊娠高血压并发症以及新生儿并发症(包括胎儿生长受限、早产和死胎)的风险增加。然而,通过适当的孕前咨询、生育评估和支持、健康优化和循证产前护理,大多数患者都能获得良好的结果。应在妊娠前、妊娠期和哺乳期审查用药安全性,权衡疾病复发的风险和对后代的潜在不良影响。需要进一步研究的重要领域包括:最佳分娩时间、妊娠对慢性肾脏病患者心血管和肾脏的短期和长期影响,以及对其后代肾脏和心血管的长期影响。
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来源期刊
Nature Reviews Nephrology
Nature Reviews Nephrology 医学-泌尿学与肾脏学
CiteScore
39.00
自引率
1.20%
发文量
127
审稿时长
6-12 weeks
期刊介绍: Nature Reviews Nephrology aims to be the premier source of reviews and commentaries for the scientific communities it serves. It strives to publish authoritative, accessible articles. Articles are enhanced with clearly understandable figures, tables, and other display items. Nature Reviews Nephrology publishes Research Highlights, News & Views, Comments, Reviews, Perspectives, and Consensus Statements. The content is relevant to nephrologists and basic science researchers. The broad scope of the journal ensures that the work reaches the widest possible audience.
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