title: Vegetarian supplemented low-protein diets. A safe option for pregnant CKD patients: report of 12 pregnancies in 11 patients.
abstract: BACKGROUND
  Pregnancy in CKD is an increasing challenge, considering also the paucity of therapeutic tools available in pregnant women. While theoretically interesting, the experience with low protein diets in pregnancy is limited. Aim of this feasibility study is to review our experience with supplemented vegetarian low protein diets in pregnancy, as a "rescue treatment" for severe CKD and/or proteinuria.
  
  
  METHODS
  Data were gathered prospectively. Diet schema: proteins: 0.6-0.7 g/Kg/day, amino and chetoacid supplementation, 1-3 free meals/week. Compliance, side effects, biochemical data recorded at each visit (at least twice monthly).
  
  
  RESULTS
  Between January 2000 and February 2010, out of 168 pregnancies referred, 12 were managed by the diet (11 patients; median age 33, range 20-38). One pregnancy was terminated (patient's choice); the other 10 patients delivered 11 healthy babies. At referral, 2 patients were in stage 4 CKD, 4 in stage 3, 4 had nephrotic proteinuria (3.6-6.3 g/day). One patient doubled serum creatinine; none needed renal replacement therapy within 6 months from delivery. No patient complained of side effects, nor developed hyperkalemia or hypercalcaemia. Two babies from mothers in CKD stage 4 were small for gestational age; 9/11 were delivered by caesarean section (median gestational age 33 weeks: range 28-37; birth weight 935-2620 g) within a policy of delivery in the presence of foetal growth impairment and/or worsening of proteinuria, GFR, hypertension or foetal conditions. All babies are well, 1 month, 7.5 years from delivery.
  
  
  CONCLUSIONS
  Our report suggests considering vegetarian diets as an additional tool in the management of pregnant CKD patients.
authors.affiliation: SS Nefrologia, Department of Clinical and Biological Sciences, ASOU San Luigi, University of Torino, Italy. gbpiccoli@yahoo.it
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Elena
authors.initials: E
authors.lastname: Vasario
authors.forename: Pietro
authors.initials: P
authors.lastname: Gaglioti
authors.forename: Ettore
authors.initials: E
authors.lastname: Piccoli
authors.forename: Valentina
authors.initials: V
authors.lastname: Consiglio
authors.forename: Chiara
authors.initials: C
authors.lastname: Deagostini
authors.forename: Manuela
authors.initials: M
authors.lastname: Oberto
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D003404:Creatinine; D018753:Diet, Protein-Restricted; D014676:Diet, Vegetarian; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000178:diet therapy*; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D003404:Creatinine