Following renal disorder is associated with worst pregnancy outcome:
High-Yield Explanation
Prognostic indicators in renal disease and pregnancy:
Most reliable prognostic indicator of the outcome of pregnancy is the presence of hypertension. The fetal prognosis for women with chronic renal disease is favorable as long as they do not develop superimposed preeclampsia.
Second to hypertension, the most valuable prognostic index for patients with chronic renal disease during pregnancy is the degree of renal function impairment:
– In patients with normal or only midly impaired renal function, pregnancy does not accelerate renal damage
– In patients with moderate renal insufficiency (serum creatinine of 1.4 mg/dL or greater before pregnancy or creatinine clearance <30 ml/min. there is a decline in renal function during pregnancy).
Another important prognostic sign is the presence or absence of proteinuria. As a general rule, if the patient has 2+ or more protein in qualitative tests or 3 g or more in 24 hours urine collections at the beginning of pregnancy, the tendency will be toward increased protein losses and development of nephritic syndrome during pregnancy.
The histologic characteristics of the renal lesion also have prognostic value.