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


  • Giorgina B. Piccoli, Sara Ghiotto, Roberta Clari, Federica Neve Vigotti, Irene Moro SS 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 Pilloni Gynecology and Obstetrics 2U Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
  • Giorgio Grassi Endocrinology, Diabetology and Metabolism Unit, Città Della Salute e Della Scienza Hospital, Turin, Italy
  • Domenica Giuffrida , Alessandro Rolfo, Tullia Todros Department of Surgical Science, University of Turin, Turin, Italy


type 1 diabetes · diabetic nephropathy · pregnancy · pre-term delivery · nephritic syndrome


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.