Severe kidney dysfunction after assisted reproductive technology: a case series suggesting the need for higher awareness of risks.

Abstract

Background: Assisted reproductive technology (ART) has significantly increased the rate of conception and live births in women with fertility problems. Having a kidney disease negatively affects a woman's reproductive health, making infertility a significant concern, and women with chronic kidney disease (CKD) are increasingly seeking treatment with assisted reproductive technology. The side effects of assisted reproductive technology are not fully known and its impact on kidney function, especially if a woman has undergone repeated treatments, is likewise not known.

Methods: This case series gathers all consecutive patients who were followed by the Mansoura University Hospital's Obstetric Nephrology Service or were admitted to its Nephrology and Gynecology Department during pregnancy with a diagnosis of acute or chronic kidney function impairment after conceiving with an assisted reproductive technology method, in the period from 2021 to 2024.

Results: Of the approximately 150 pregnancies referred to the Obstetric Nephrology Clinic, 6 were referred for acute or acute-on-chronic kidney function impairment, or nephrotic syndrome after conceiving via assisted reproductive technology. In one patient, CKD was overlooked and later progressed to kidney failure; one had probable CKD, but discontinued follow-up before confirmation; and one had a kidney malformation, diagnosed during pregnancy. All presented with early or very early severe hypertension and proteinuria, before 20 weeks, while preeclampsia and the hypertensive disorders of pregnancy are conventionally defined as developing after 20 weeks of gestation. Three had complete recovery postpartum, one progressed to kidney failure, while two were lost to follow-up.

Conclusion: Severe early-pregnancy kidney impairment after assisted reproductive technology is probably more frequent than previously reported. Assessment of kidney function after assisted reproductive technology should be mandatory, to make it possible for timely specialized kidney care to be given.