Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy – A Case Series
Giorgina B. Piccoli, Sara Ghiotto, Roberta Clari, Federica Neve Vigotti, Irene MoroSS Nephrology, Department of Medical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
Elisabetta Tavassoli, Carmela Melluzza, Clara Monzeglio , Valentina Donvito , Filomena Leone , Rossella Attini, Federica Fassio , Silvia Parisi , Eleonora PilloniGynecology and Obstetrics 2U Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
Giorgio GrassiEndocrinology, Diabetology and Metabolism Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
Domenica Giuffrida , Alessandro Rolfo, Tullia TodrosDepartment of Surgical Science, University of Turin, Turin, Italy
BACKGROUND: Diabetes and nephropathy are important challenges during pregnancy, increasingly encountered because of the advances in maternal-fetal care. AIM: To evaluate the maternal and fetal outcomes recorded in “severe” diabetic nephropathy in type 1 diabetic patients referred to nephrological healtcare. METHODS: The study was performed in an outpatient unit dedicated to kidney diseases in pregnancy (with joint nephrological and obstetric follow-up and strict cooperation with the diabetes unit). 383 pregnancies were referred to the outpatient unit in 2000-2012, 14 of which were complicated by type 1 diabetes. The report includes 12 deliveries, including 2 pregnancies in 1 patient; one twin pregnancy; 2 spontaneous abortions were not included. All cases had long-standing type 1 diabetes (median of 21 (15-31) years), relatively high median age (35 (29-40) years) and end-organ damage (all patients presented lasertreated retinopathy and half of them clinical neuropathy). Median glomerular filtration rate (GFR) at referral was 67 ml/min (48-122.6), proteinuria was 1.6 g/day (0.1-6.3 g/day). RESULTS: Proteinuria steeply increased in 11/12 patients, reaching the nephrotic range in nine (6 above 5 g/day). One patient increased by 2 chronic kidney disease (CKD) stages. Support therapy included blood pressure and diabetes control, bed rest, and moderate protein restriction. All children were preterm (7 early preterm); early spontaneous labor occurred in 4/12 patients. All singletons were appropriate for gestational age and developed normally after birth. The male twin child died 6 days after birth (after surgery for great vessel transposition). CONCLUSIONS: Diabetic patients with severe diabetic nephropathy are still present a considerable challenge. Therefore, further investigations are required, particularly on proteinuria management and the occurrence of spontaneous labor.
Keywordstype 1 diabetes · diabetic nephropathy · pregnancy · pre-term delivery · nephritic syndrome,.
Rev Diabet Stud