Decoding Maternal Kidney Function in Pregnancy: A Systematic Exploration
In a quest to unravel the mysteries surrounding maternal kidney function during pregnancy, V. A. Lopes van Balen, T. A. G. van Gansewinkel, S. de Haas, J. J. Spaan, C. Ghossein-Doha, S. M. J. van Kuijk, J. van Drongelen, T. Cornelis, and M. E. A. Spaanderman conducted a systematic review and meta-analysis, presenting a comprehensive overview of kidney function changes over the course of both healthy and complicated singleton pregnancies.
Objectives: Peering into Kidney Adaptations
The study's objectives were laid out meticulously, aiming to systematically review existing literature on kidney function changes during pregnancy. This endeavor sought to estimate the extent of adaptation during both healthy physiological and complicated singleton pregnancies while determining reference values for healthy pregnancies.
Methods: Navigating Research Horizons
The researchers delved into PubMed (NCBI) and EMBASE (Ovid) electronic databases, conducting a thorough search from inception to July 2017. The inclusion criteria demanded studies reporting a non-pregnant reference value of kidney function and a pregnancy measurement at a predetermined gestational age. Kidney function measures included glomerular filtration rate (GFR) via inulin clearance, GFR via creatinine clearance, and serum creatinine level. Pooled mean differences between pregnancy measurements and reference values were calculated for specific gestational intervals in both uncomplicated and complicated pregnancies using a random-effects model.
Results: Unveiling Pregnancy's Impact on Kidney Function
The analysis, incorporating 29 studies, painted a vivid picture. As early as the first trimester, GFR surged by up to 40–50% in physiological pregnancy compared with non-pregnant values. Inulin clearance peaked at 36–41 weeks with a 55.6% increase, creatinine clearance at 15–21 weeks with a 37.6% increase, and serum creatinine level decreased by 23.2% at 15–21 weeks in uncomplicated pregnancies. In hypertensive pregnancy, a significant difference in all kidney function parameters was noted, showcasing a decrease compared to uncomplicated pregnancies.
Conclusions: A Symphony of Kidney Function Dynamics
The meta-analysis painted a symphony of kidney function dynamics during pregnancy. In healthy pregnancies, GFR saw an early surge in the first trimester, maintaining an elevated rate throughout gestation. However, in pregnancies complicated by hypertension, kidney function experienced a notable decrease. This comprehensive exploration, published by The Authors in Ultrasound in Obstetrics & Gynecology, opens avenues for a deeper understanding of the intricate dance between maternal physiology and kidney adaptations during the transformative journey of pregnancy.
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