• Johnson D. Pregnancy. Nephrology 2006 Apr;11(S1):S41-3.



• Johnson D. Pregnancy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 Jul. 8 p. [33 references]

This is the current release of the guideline.

• Chronic kidney diseases
• Pregnancy

Management
Treatment

Family Practice
Internal Medicine
Nephrology
Obstetrics and Gynecology
Pediatrics

Physicians

To review the available clinical evidence pertaining to the effect of pregnancy on the rate of glomerular filtration rate decline in chronic kidney disease

Pregnant women with chronic kidney disease

Provision of advice to patients who are trying to conceive

Deterioration of renal function

Searches of Electronic Databases

Databases searched: Medline (1996 to November Week 2, 2003). MeSH terms for kidney disease were combined with MeSH terms for pregnancy. The results were then limited to cohort and case-control studies.

Date of search: 16 December 2003.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding pregnancy in chronic kidney disease from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, UK Renal Association, Canadian Society of Nephrology, European Best Practice Guidelines, and International Guidelines.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

Guidelines

No recommendations possible based on Level I or II evidence.

Suggestions for Clinical Care

(Suggestions are based on Level III and IV sources)

• Pregnancy generally does not affect the course of renal disease in women who have normal or near-normal renal function at conception. Such individuals should not be discouraged from conceiving purely on the basis of their renal disease. (Level II–III evidence; retrospective cohort and case control studies; clinically relevant outcomes; inconsistent effects).
• Renal function deterioration is probably accelerated by pregnancy in patients with poorly-controlled hypertension or plasma creatinine concentrations of > 0.20 mmol/L at conception. The magnitude of this increase in risk compared with non-pregnant individuals with renal disease has not been established. (Level II–III evidence; retrospective cohort and case-control studies; clinically relevant outcomes; inconsistent effects).

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate management of women with chronic kidney disease who are pregnant or are trying to conceive

Deterioration of renal function

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Johnson D. Pregnancy. Nephrology 2006 Apr;11(S1):S41-3.



• Johnson D. Pregnancy. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2004 Jul. 8 p. [33 references]

Not applicable: The guideline was not adapted from another source.

2006 Apr

Caring for Australasians with Renal Impairment - Disease Specific Society

Industry-sponsored funding administered through Kidney Health Australia

Not stated

Author: David Johnson (Woolloongabba, Queensland)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on April 26, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.