title: Severe diabetic nephropathy in type 1 diabetes and pregnancy--a case series.
abstract: BACKGROUND
  Diabetes and nephropathy are important challenges during pregnancy, increasingly encountered because of the advances in maternal-fetal care.
  
  
  OBJECTIVE
  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 laser-treated 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.
authors.affiliation: SS Nephrology, Department of Medical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.
authors.forename: Giorgina B
authors.initials: GB
authors.lastname: Piccoli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tavassoli
authors.forename: Carmela
authors.initials: C
authors.lastname: Melluzza
authors.forename: Giorgio
authors.initials: G
authors.lastname: Grassi
authors.forename: Clara
authors.initials: C
authors.lastname: Monzeglio
authors.forename: Valentina
authors.initials: V
authors.lastname: Donvito
authors.forename: Filomena
authors.initials: F
authors.lastname: Leone
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.forename: Sara
authors.initials: S
authors.lastname: Ghiotto
authors.forename: Roberta
authors.initials: R
authors.lastname: Clari
authors.forename: Irene
authors.initials: I
authors.lastname: Moro
authors.forename: Federica
authors.initials: F
authors.lastname: Fassio
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Pilloni
authors.forename: Federica N
authors.initials: FN
authors.lastname: Vigotti
authors.forename: Domenica
authors.initials: D
authors.lastname: Giuffrida
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rolfo
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000328:Adult; D001794:Blood Pressure; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000503:physiopathology*