title: Hypertension in CKD Pregnancy: a Question of Cause and Effect (Cause or Effect? This Is the Question).
abstract: Chronic kidney disease (CKD) is increasingly encountered in pregnancy, and hypertension is frequently concomitant. In pregnancy, the prevalence of CKD is estimated to be about 3%, while the prevalence of chronic hypertension is about 5-8%. The prevalence of hypertension and CKD in pregnancy is unknown. Both are independently related to adverse pregnancy outcomes, and the clinical picture merges with pregnancy-induced hypertension and preeclampsia. Precise risk quantification is not available, but risks linked to CKD stage, hypertension, and proteinuria are probably multiplicative, each at least doubling the rates of preterm and early preterm delivery, small for gestational age babies, and related outcomes. Differential diagnosis (based upon utero-placental flows, fetal growth, and supported by serum biomarkers) is important for clinical management. In the absence of guidelines for hypertension in CKD pregnancies, the ideal blood pressure goal has not been established; we support a tailored approach, depending on compliance, baseline control, and CKD stages, with strict blood pressure monitoring. The choice of antihypertensive drugs and the use of diuretics and of erythropoiesis-stimulating agents (ESAs) are still open questions which only future studies may clarify.
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy. gbpiccoli@yahoo.it.|Nephrologie, Centre Hospitalier Le Mans, Le Mans, France. gbpiccoli@yahoo.it.
authors.forename: Giorgina Barbara
authors.initials: GB
authors.lastname: Piccoli
authors.affiliation: SCD Nefrologia, AO Brotzu, Piazzale Ricchi, 1, Cagliari, Italy.
authors.forename: Gianfranca
authors.initials: G
authors.lastname: Cabiddu
authors.affiliation: SCDU Obstetrics, Department of Surgery, Città della salute e della Scienza, Torino, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Attini
authors.affiliation: SCDU Obstetrics, Department of Surgery, Città della salute e della Scienza, Torino, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Parisi
authors.affiliation: SCDU Obstetrics, Department of Surgery, Città della salute e della Scienza, Torino, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Fassio
authors.affiliation: SCD Nefrologia, AO Brotzu, Piazzale Ricchi, 1, Cagliari, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Loi
authors.affiliation: SS Nephrology, Department of Clinical and Biological Sciences, AOU san Luigi, Regione Gonzole 10, Orbassano, Torino, Italy.
authors.forename: Martina
authors.initials: M
authors.lastname: Gerbino
authors.affiliation: SCDU Obstetrics, Department of Surgery, Città della salute e della Scienza, Torino, Italy.
authors.forename: Marilisa
authors.initials: M
authors.lastname: Biolcati
authors.affiliation: SCD Nefrologia, AO Brotzu, Piazzale Ricchi, 1, Cagliari, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: Pani
authors.affiliation: SCDU Obstetrics, Department of Surgery, Città della salute e della Scienza, Torino, Italy.
authors.forename: Tullia
authors.initials: T
authors.lastname: Todros
mesh_terms: D000818:Animals; D001794:Blood Pressure; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000503:physiopathology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D011795:Surveys and Questionnaires
keywords: Chronic kidney disease; Hypertension; Preeclampsia; Pregnancy; Pregnancy outcomes