Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy – A Case Series

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Abstract
The Review of Diabetic Studies,2013,10,1,68-78.
Published:May 2013
Type:Original Article
Authors:
Author(s) affiliations:

Giorgina B. Piccoli1, Elisabetta Tavassoli2, Carmela Melluzza2, Giorgio Grassi3, Clara Monzeglio2, Valentina Donvito2, Filomena Leone2, Rossella Attini2, Sara Ghiotto1, Roberta Clari1, Irene Moro1, Federica Fassio2, Silvia Parisi2, Eleonora Pilloni2, Federica Neve Vigotti1, Domenica Giuffrida4, Alessandro Rolfo4, and Tullia Todros2,4

1SS Nephrology, Department of Medical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, ITALY.

2Gynecology and Obstetrics 2U Unit, Città Della Salute e Della Scienza Hospital, Turin, ITALY.

3Endocrinology, Diabetology and Metabolism Unit, Città Della Salute e Della Scienza Hospital, Turin, ITALY.

4Department of Surgical Science, University of Turin, Turin, ITALY.

Abstract:

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). Conclusion: 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.