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American Journal of Kidney Diseases

Association of Unilateral Renal Agenesis With Adverse Outcomes in Pregnancy: A Matched Cohort Study

Published:April 07, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.02.367

      Background

      Data regarding the effect of a solitary kidney during pregnancy have come from studies of living kidney donors. We evaluated the risk for adverse pregnancy outcomes in women with a single kidney from renal agenesis.

      Study Design

      Matched cohort study.

      Setting & Participants

      Using data from 7,079 childbirths from an integrated health care delivery system from 1996 through 2015, we identified births from women with renal agenesis. Only first pregnancies and singleton births were included. After excluding those with diabetes and kidney disease, 200 women with renal agenesis were matched 1:4 by age (within 2 years), race, and history of hypertension to women with 2 kidneys.

      Predictor

      Renal agenesis defined by International Classification of Diseases, Ninth Revision (ICD-9) codes prior to pregnancy.

      Outcomes

      The primary outcome was adverse maternal outcomes, including preterm delivery, delivery by cesarean section, preeclampsia/eclampsia, and hospital length of stay. Adverse neonatal end points were considered as a secondary outcome and included low birth weight (<2,500 g) and infant death/transfer to acute inpatient facility.

      Results

      Mean gestational age at delivery was 37.9 ± 2.1 weeks for women with renal agenesis compared to 38.6 ± 1.8 weeks for women with 2 kidneys. Compared with women with 2 kidneys, those with renal agenesis had increased risk for preterm delivery (OR, 2.88; 95% CI, 1.86-4.45), delivery by cesarean section (OR, 2.11; 95% CI, 1.49-2.99), preeclampsia/eclampsia (OR, 2.41; 95% CI, 1.23-4.72), and length of stay longer than 3 days (OR, 1.81; 95% CI, 1.18-2.78). Renal agenesis was not significantly associated with increased risk for infant death/transfer to acute facility (OR, 2.60; 95% CI, 0.57-11.89) or low birth weight after accounting for preterm delivery (OR, 2.11; 95% CI, 0.76-5.88).

      Limitations

      Renal agenesis was identified by ICD-9 code, not by imaging of the abdomen.

      Conclusion

      Women with unilateral renal agenesis have a higher risk for adverse outcomes in pregnancy.

      Index Words

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      References

        • Williams D.
        • Davison J.
        Chronic kidney disease in pregnancy.
        BMJ. 2008; 336: 211-215
        • Piccoli G.B.
        • Attini R.
        • Vasario E.
        • et al.
        Pregnancy and chronic kidney disease: a challenge in all CKD stages.
        Clin J Am Soc Nephrol. 2010; 5: 844-855
        • Nevis I.F.
        • Reitsma A.
        • Dominic A.
        • et al.
        Pregnancy outcomes in women with chronic kidney disease: a systematic review.
        Clin J Am Soc Nephrol. 2011; 6: 2587-2598
        • Piccoli G.
        • Attini R.
        • Vigotti F.N.
        • et al.
        Is renal hyperfiltration protective in chronic kidney disease-stage 1 pregnancies? A step forward unraveling the mystery of the effect of stage 1 chronic kidney disease on pregnancy outcomes.
        Nephrology. 2015; 20: 201-208
        • Garg A.X.
        • McArthur E.
        • Lentine K.L.
        Donor Nephrectomy Outcomes Research (DONOR) Network. Gestational hypertension and preeclampsia in living kidney donors.
        N Engl J Med. 2015; 372: 124-133
        • Ibrahim H.N.
        • Akkina S.K.
        • Lesiter E.
        • et al.
        Pregnancy outcomes after kidney donation.
        Am J Transplant. 2009; 9: 825-834
        • Sanna-Cherchi S.
        • Ravani P.
        • Corbani V.
        • et al.
        Renal outcome in patients with congenital anomalies of the kidney and urinary tract.
        Kidney Int. 2009; 76: 528-533
      1. Intermountain Healthcare. 2015 Annual Report. https://intermountainhealthcare.org/assets/PDF/annualreport2015.pdf. Accessed October 14, 2016.

      2. American Medical Association. Hospital International Classification of Diseases, 9th Revision, Clinical Modification Codes. Maryland Heights, MO: Saunders. 2009.

        • National Kidney Foundation
        K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.
        Am J Kidney Dis. 2002; 39: S1-S266
      3. Coca-Perraillon M. Matching with propensity scores to reduce bias in observational studies. Proceedings of the Northeast SAS Users Group (NESUG), September 2006. http://www.lexjansen.com/nesug/nesug06/an/da13.pdf. Accessed September 14, 2016.

        • Kendrick J.
        • Sharma S.
        • Holmen J.
        • Palit S.
        • Nuccio E.
        • Chonchol M.
        Kidney disease and maternal outcomes in pregnancy.
        Am J Kidney Dis. 2015; 66: 55-59
        • Kuss O.
        • McLerran D.
        A note on the estimation of the multinomial logistic model with correlated responses in SAS.
        Comput Methods Programs Biomed. 2007; 87: 262-269
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gotzshe P.C.
        • Vandenbroucke J.P.
        STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Fehrman-Ekholm I.
        • Norden G.
        • Lennerling A.
        • et al.
        Incidence of end-stage renal disease among live kidney donors.
        Transplantation. 2006; 82: 1646-1648
        • Argueso L.R.
        • Ritchey M.L.
        • Boyle Jr., E.T.
        • Milliner D.S.
        • Bergstrailh E.J.
        • Kramer S.A.
        Prognosis of patients with unilateral renal agenesis.
        Pediatr Nephrol. 1992; 6: 412-416
        • Baylis C.
        Glomerular filtration rate in normal and abnormal pregnancies.
        Semin Nephrol. 1999; 19: 133-139
        • Heguilen R.M.
        • Liste A.A.
        • Belllusci A.D.
        • Lapidus A.M.
        • Bernasconi A.R.
        Renal response to an acute protein challenge in pregnant women with borderline hypertension.
        Nephrology (Carlton). 2007; 12: 254-260
        • Livi R.
        • Guiducci S.
        • Perfetto F.
        • et al.
        Lack of activation of renal functional reserve predicts the risk of significant renal involvement in systemic sclerosis.
        Ann Rheum Dis. 2011; 70: 1963-1967
        • Ankumah N.E.
        • Sibai B.M.
        Chronic hypertension in pregnancy: diagnosis, management, and outcomes.
        Clin Obstet Gynecol. 2017; 60: 206-214
        • Singh H.
        • Murphy H.R.
        • Hendrieckx C.
        • Ritterband L.
        • Speight J.
        The challenges and future considerations regarding pregnancy-related outcomes in women with pre-existing diabetes.
        Curr Diabetes Rep. 2013; 13: 869-876
        • Li S.
        Association of renal agenesis and mullerian duct anomalies.
        J Comput Assist Tomogr. 2000; 24: 829-834
        • Stein A.L.
        • March C.M.
        Pregnancy outcome in women with mullerian duct anomalies.
        J Reprod Med. 1990; 35: 411-414
        • Piccoli G.B.
        • Cabiddu G.
        • Attini R.
        • et al.
        Risk of adverse pregnancy outcomes in women with CKD.
        J Am Soc Nephrol. 2015; 26: 2011-2022
        • Jones J.
        • Holmen J.
        • De Graauw J.
        • Jovanovich A.
        • Thornton S.
        • Chonchol M.
        Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality.
        Am J Kidney Dis. 2012; 60: 402-408