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Article ; Online: Kidney Biopsy in a Pregnant Patient with Suspected Glomerular Disease: Commentary.

Hladunewich, Michelle A

Kidney360

2023 Volume 4, Issue 10, Page(s) 1359–1361

MeSH term(s)	Humans ; Pregnancy ; Female ; Kidney Diseases/diagnosis ; Kidney/pathology ; Biopsy
Language	English
Publishing date	2023-08-21
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2641-7650
ISSN (online)	2641-7650
DOI	10.34067/KID.0000000000000244
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Authors' Reply: Renal Function and Adverse Maternal and Fetal Outcomes: New Evidence.

Tangren, Jessica / Hladunewich, Michelle A

Journal of the American Society of Nephrology : JASN

2023 Volume 34, Issue 8, Page(s) 1472

MeSH term(s)	Fetus ; Kidney/physiology
Language	English
Publishing date	2023-08-01
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	1085942-1
ISSN	1533-3450 ; 1046-6673
ISSN (online)	1533-3450
ISSN	1046-6673
DOI	10.1681/ASN.0000000000000169
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Zs.A 3344: Show issues

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Article ; Online: Nephrology and women's health post-Roe v. Wade: we must do better.

Qi, Amy / Hladunewich, Michelle A

Nature reviews. Nephrology

2022 Volume 18, Issue 12, Page(s) 741–742

MeSH term(s)	Female ; Humans ; United States ; Nephrology ; Women's Health ; Government Regulation
Language	English
Publishing date	2022-09-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2490366-8
ISSN	1759-507X ; 1759-5061
ISSN (online)	1759-507X
ISSN	1759-5061
DOI	10.1038/s41581-022-00634-4
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Zs.A 6334: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MG 107: Show issues

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Article ; Online: Pregnancy in Patients Receiving Home Dialysis.

Ankawi, Ghada / Tangirala, Nishanta / Jesudason, Shilpanjali / Hladunewich, Michelle A

Clinical journal of the American Society of Nephrology : CJASN

2024

Abstract: Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if ... ...

Abstract	Pregnancy is an important goal for many women with CKD or kidney failure, but important barriers exist, particularly as CKD stage progresses. Women with advanced CKD often have a limited fertility window and may miss their opportunity for a pregnancy if advised to defer until after kidney transplantation. Pregnancy rates in women with advanced kidney failure or receiving dialysis remain low, and despite the improved outcomes in recent years, these pregnancies remain high risk for both mother and baby with high rates of preterm birth due to both maternal and fetal complications. However, with increased experience and advances in models of care, this paradigm may be changing. Intensive hemodialysis regimens have been shown to improve both fertility and live birth rates. Increasing dialysis intensity and individualizing dialysis prescription to residual renal function, to achieve highly efficient clearances, has resulted in improved live birth rates, longer gestations, and higher birth weights. Intensive hemodialysis regimens, particularly nocturnal and home-based dialysis, are therefore a potential option for women with kidney failure desiring pregnancy. Global initiatives for the promotion and uptake of home-based dialysis are gaining momentum and may have advantages in this unique patient population. In this article, we review the epidemiology and outcomes of pregnancy in hemodialysis and peritoneal dialysis recipients. We discuss the role home-based therapies may play in helping women achieve more successful pregnancies and outline the principles and practicalities of management of dialysis in pregnancy with a focus on delivery of home modalities. The experience and perspectives of a patient are also shared.
Language	English
Publishing date	2024-01-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2226665-3
ISSN	1555-905X ; 1555-9041
ISSN (online)	1555-905X
ISSN	1555-9041
DOI	10.2215/CJN.0000000000000437
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Zs.A 6584: Show issues

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Article ; Online: Chronic Kidney Disease and Pregnancy.

Hladunewich, Michelle A

Seminars in nephrology

2017 Volume 37, Issue 4, Page(s) 337–346

Abstract: Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of their kidney disease, and adverse pregnancy complications such as preeclampsia and ... ...

Abstract	Women with chronic kidney disease (CKD) are at risk for adverse pregnancy-associated outcomes, including progression of their underlying renal dysfunction, a flare of their kidney disease, and adverse pregnancy complications such as preeclampsia and preterm delivery. Earlier-stage CKD, as a rule, is a safer time to have a pregnancy, but even women with end-stage kidney disease have attempted pregnancy in recent years. As such, nephrologists need to be comfortable with pregnancy preparation and management at all stages of CKD. In this article, we review the renal physiologic response to pregnancy and the literature with respect to both expected maternal and fetal outcomes among young women at various stages of CKD, including those who attempt to conceive while on dialysis. The general management of young women with CKD and associated complications, including hypertension and proteinuria are discussed. Finally, the emotional impact these pregnancies may have on young women with a chronic disease and the potential benefits of care in a multidisciplinary environment are highlighted.
Language	English
Publishing date	2017-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	604652-6
ISSN	1558-4488 ; 0270-9295
ISSN (online)	1558-4488
ISSN	0270-9295
DOI	10.1016/j.semnephrol.2017.05.005
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Se 784: Show issues

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Article ; Online: End-Stage Kidney Disease and Dialysis in Pregnancy.

Oliverio, Andrea L / Hladunewich, Michelle A

Advances in chronic kidney disease

2020 Volume 27, Issue 6, Page(s) 477–485

Abstract: End-stage kidney disease is associated with low fertility, with rates of conception in women on dialysis estimated at 1/100th of the general population. However, live birth rates are increasing over time in women on hemodialysis, whereas they remain ... ...

Abstract	End-stage kidney disease is associated with low fertility, with rates of conception in women on dialysis estimated at 1/100th of the general population. However, live birth rates are increasing over time in women on hemodialysis, whereas they remain lower and static in women on peritoneal dialysis. Intensification of hemodialysis, targeting a serum blood urea nitrogen <35 mg/dL or 36 hours of dialysis per week in women with no residual kidney function, is associated with improved live birth rates and longer gestational age. Even in intensively dialyzed cohorts, rates of prematurity and need for neonatal intensive care are high, upwards of 50%. Although women on peritoneal dialysis in pregnancy do not appear to be at increased risk of delivering preterm compared with those on hemodialysis, their infants are more likely to be small for gestational age. As such, hemodialysis has emerged as the preferred dialysis modality in pregnancy. Provision of specialized nephrology, obstetric, and neonatal care is necessary to manage these complex pregnancies and family planning counseling should be offered to all women with end-stage kidney disease.
MeSH term(s)	Female ; Humans ; Kidney Failure, Chronic/etiology ; Kidney Failure, Chronic/physiopathology ; Kidney Failure, Chronic/therapy ; Pregnancy ; Pregnancy Complications/etiology ; Pregnancy Complications/physiopathology ; Pregnancy Complications/therapy ; Pregnancy Outcome ; Pregnancy, High-Risk ; Renal Dialysis/adverse effects ; Renal Dialysis/methods ; Risk Adjustment/methods
Language	English
Publishing date	2020-12-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ISSN	1548-5609 ; 1548-5595
ISSN (online)	1548-5609
ISSN	1548-5595
DOI	10.1053/j.ackd.2020.06.001
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Zs.A 4627: Show issues

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Article ; Online: Caring for Pregnant Patients With CKD---An Ethical Discussion of 5 Cases.

Hendren, Elizabeth / Hladunewich, Michelle A / Lefkowitz, Ariel

Kidney international reports

2021 Volume 6, Issue 5, Page(s) 1273–1279

Abstract: Introduction: Pregnancy planning in patients with chronic kidney disease can result in ethical conflicts due to the potential for adverse outcomes. Traditionally, many nephrologists have advised their patients to avoid pregnancy altogether; however, ... ...

Abstract	Introduction: Pregnancy planning in patients with chronic kidney disease can result in ethical conflicts due to the potential for adverse outcomes. Traditionally, many nephrologists have advised their patients to avoid pregnancy altogether; however, this approach is paternalistic and not patient-centered. An ethical framework could guide joint decision-making between physicians and their patients, but this does not currently exist. Methods: We performed a literature search to identify the ethical considerations associated with this patient population. We searched for articles published between 1975 and 2019 using the terms "ethics" and "high risk pregnancy," along with 29 chronic disease-specific MeSH terms. Subsequently, we performed a critical evaluation using established ethical theories and adapted anonymized clinical cases from the Pregnancy in Kidney Disease Clinic (PreKid Clinic) at our institution to guide the discussion. Results: We identified 968 articles and excluded 947 based on their title or abstract. Twelve full-text articles were included, representing discussions, case reports, and literature reviews on the ethics of pregnancy in 8 chronic diseases. The extracted data were applied to 5 clinical cases to guide the discussion. Conclusions: This clinical review focuses on 3 main ethical themes: duty to patient, duty to the fetus, and duty to society, to help physicians explore common scenarios that may arise when counseling patients around pregnancy. Primarily, physicians have a duty to facilitate autonomous decision-making and informed consent. Secondarily, they have a duty to protect the fetus and use resources judiciously as long as it does not impact the care of their patients.
Language	English
Publishing date	2021-02-26
Publishing country	United States
Document type	Journal Article
ISSN	2468-0249
ISSN (online)	2468-0249
DOI	10.1016/j.ekir.2021.02.020
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Article ; Online: Women's Reproductive Health for the Nephrologist.

Burgner, Anna / Hladunewich, Michelle A

American journal of kidney diseases : the official journal of the National Kidney Foundation

2019 Volume 74, Issue 5, Page(s) 675–681

Abstract: Women with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. ... ...

Abstract	Women with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. CKD itself and the therapies needed to treat severe disease can affect future fertility. When conception is desired, young women with CKD must plan meticulously because an ill-timed pregnancy can result in disease progression or flare and exposure of an unborn child to potentially teratogenic medications. Among women with CKD, pregnancy risks are substantial, with up to 10-fold higher risk for preeclampsia and 6-fold higher risk for preterm delivery. These pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity and mortality and progression to kidney failure later in life. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies, to choose treatments that preserve fertility, and to participate in shared decision making that optimizes pregnancy timing and outcomes. In this perspective, we review the many challenges associated with reproductive counseling in women with CKD.
MeSH term(s)	Family Planning Services/methods ; Female ; Global Health ; Humans ; Morbidity ; Nephrologists ; Pregnancy ; Pregnancy Complications/epidemiology ; Renal Insufficiency, Chronic/epidemiology ; Reproductive Health/standards ; Women's Health
Language	English
Publishing date	2019-06-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2019.04.017
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Zs.A 1669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 468: Show issues

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Article ; Online: Pregnancy and CKD: Advances in Care and the Legacy of Dr Susan Hou.

Oliverio, Andrea L / Bramham, Kate / Hladunewich, Michelle A

American journal of kidney diseases : the official journal of the National Kidney Foundation

2021 Volume 78, Issue 6, Page(s) 865–875

Abstract: Dr Susan Hou began her illustrious nephrology career at a time when pregnancy in women with chronic kidney disease (CKD) was hazardous and actively discouraged. Her pioneering research in women's health provided much of the early outcome data that shaped ...

Abstract	Dr Susan Hou began her illustrious nephrology career at a time when pregnancy in women with chronic kidney disease (CKD) was hazardous and actively discouraged. Her pioneering research in women's health provided much of the early outcome data that shaped our current understanding of CKD and pregnancy. Although many uncertainties regarding optimal management of this vulnerable patient group remain, recent decades have witnessed important advances and renewed interest in improving care for pregnant women with CKD. Many nephrologists have been inspired by Dr Hou's lifetime of work and are grateful for her generous collaborations. In this In Practice Review, we honor her legacy by providing an update of current literature and clinical management guidance in the context of a clinical case vignette that challenges us to consider the many complex aspects to the counseling and care of women with CKD who desire a pregnancy.
MeSH term(s)	Female ; Humans ; Nephrologists ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/therapy ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy ; Women's Health
Language	English
Publishing date	2021-10-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604539-x
ISSN	1523-6838 ; 0272-6386
ISSN (online)	1523-6838
ISSN	0272-6386
DOI	10.1053/j.ajkd.2021.07.016
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Zs.A 1669: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 468: Show issues

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Article ; Online: Chronic Kidney Disease and Pregnancy.

Hui, Dini / Hladunewich, Michelle A

Obstetrics and gynecology

2019 Volume 133, Issue 6, Page(s) 1182–1194

Abstract: Chronic kidney disease represents a heterogeneous group of disorders characterized by alterations in the structure and function of the kidney. Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes, and these ... ...

Abstract	Chronic kidney disease represents a heterogeneous group of disorders characterized by alterations in the structure and function of the kidney. Chronic kidney disease significantly increases the risk of adverse maternal and perinatal outcomes, and these risks increase with the severity of the underlying renal dysfunction, degree of proteinuria, as well as the frequent coexistence of hypertension. Further, renal anatomic changes result in dilatation of the collecting system, and physiologic adaptations include alterations in the balance of vasodilatory and vasoconstrictive hormones, resulting in decreased systemic and renal vascular resistance, increased glomerular filtration rate, and modifications in tubular function. These alterations have important clinical implications and can make the diagnosis of renal compromise challenging. The effect of pregnancy on kidney disease may manifest as a loss of renal function, particularly in the context of concomitant hypertension and proteinuria, and chronic kidney disease, even when mild, contributes to the high risk of adverse pregnancy outcomes, including increased risks of preeclampsia, preterm delivery, and small-for-gestational age neonates. Strategies for optimization of pregnancy outcomes include meticulous management of hypertension and proteinuria where possible and the initiation of preeclampsia prevention strategies, including aspirin. Avoidance of nephrotoxic and teratogenic medications is necessary, and renal dosing of commonly used medications must also be considered. Mode of delivery in women with chronic kidney disease should be based on usual obstetric indications, although more frequent prenatal assessments by an expert multidisciplinary team are desirable for the care of this particularly vulnerable patient population. Obstetricians represent a critical component of this team responsible for managing each stage of pregnancy to optimize both maternal and neonatal outcomes, but collaboration with nephrology colleagues in combined clinics wherein both specialists can make joint management decisions is typically very helpful.
MeSH term(s)	Aspirin/therapeutic use ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension, Pregnancy-Induced/etiology ; Infant, Newborn ; Kidney/anatomy & histology ; Kidney/physiopathology ; Kidney Transplantation ; Pre-Eclampsia/prevention & control ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/therapy ; Pregnancy Outcome ; Premature Birth/etiology ; Proteinuria/etiology ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy ; Risk Factors
Chemical Substances	Aspirin (R16CO5Y76E)
Language	English
Publishing date	2019-06-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000003256
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