MP203
A SYSTEMATIC REVIEW ON MATERNAL AND FOETAL OUTCOMES IN PREGNANT WOMEN WITH IGA NEPHROPATHY: A CASE OF LATE MATERNAL PREECLAMPSIA?

INTRODUCTION AND AIMS: Background: IgA nephropathy is the most common primary glomerulonephritis in pregnancy. As several recent studies provide information on pregnancy-related outcomes, a systematic review may help interpreting their heterogeneous results and improve information for counseling.

Objective: To analyze pregnancy-related outcomes in literature on IgA nephropathy, to perfect the estimation of the risks and to identify specific research needs.

METHODS: Search strategy: Medline, EMBASE and the Cochrane review databases were searched for the period 2000-2016. Selection criteria: We included all studies with at least 6 cases of IgA nephropathy, with or without control groups. Case reports were gathered to look into specific rare occurrences. Data collection and analysis: We extracted data on characteristics of the case series. Analysis was performed in comparison to the provided control group, if available (available only for kidney function), or to a large series of low-risk pregnancies (Preeclampsia (PE), pregnancy induced hypertension (PIH), preterm birth, small babies). Case reports were analyzed narratively.

RESULTS: The search retrieved 522 papers, of which 21 were included: 9 case series and 12 case reports. The series report on 374 women with 498 pregnancies, and on 194 non-pregnant controls analysed for progression of IgA nephropathy. No significant difference in kidney function decline was found in any of the case series in women with and without pregnancy, possibly due to the overall preserved kidney function at baseline. The case reports regard complex situations or dialysis patients, underlining the difficulties in managing cases without a preserved kidney function. Meta-analysis: incidence of end stage renal disease was low and did not differ between cases and controls (4/198 cases, 4/149 controls), but these reassuring outcomes have to be contextualised to patients with good renal function. Conversely, risk for adverse pregnancy-related outcomes was increased compared to low-risk controls: for PE (OR 10.41; CI: 5.26-10.62), PIH (OR 27.11; CI 7.51-97.83), and preterm birth (OR 2.12; CI 1.02 4.40), while the incidence of “low birth weight babies” was not statistically different (OR 1.45 IC: 0.7-2.98). This pattern suggests the presence of “maternal”, late PE that may affect less severely foetal growth.

CONCLUSIONS: IgA nephropathy is not associated with an increased progression of kidney disease, at least in cases with well preserved baseline function; an increased risk of PIH and PE, and of preterm, but not early preterm delivery, suggest the occurrence of “maternal” PE. This finding may be of help in defining control policies, but further research is needed to guide clinical management.