T.A. Mar’yAnova

The publication is devoted to the Dopplerographic examination of the renal arteries in pregnant women with chronic kidney disease (CKD) of various stages. An overview of data on the arterial renal bed and a technique for obtaining ultrasound imaging and Dopplerographic measurement of the interlobar arteries of the kidneys are presented, since it is most informative to evaluate the peak systolic velocity (PSV) in the arteries of the renal parenchyma (namely, in the interlobar arteries) for the diagnosis of renal dysfunction already at the initial stages of CKD. The diagnostic significance of the Dopplerographic parameter of peak systolic velocity (PSV) of the interlobar arteries for determining the presence of CKD and chronic renal failure (CRF) in pregnant women by trimester is highlighted. Dopplerography with assessment of the PSV of the interlobar arteries of the kidneys can be used as a non-invasive, affordable, reproducible and inexpensive screening method for CKD in the gestational period.

Возможности применения допплерографии при плоскоклеточной интраэпителиальной неоплазии шейки матки

Objective. Formation of an algorithm for the management of pregnant women with CKD to improve obstetric, perinatal and nephrological outcomes. Material and methods. The proposed algorithm for the management of pregnant women with chronic kidney disease is based on an analysis of the management and outcomes of pregnancy in 311 patients with CRF of different stages: 197 with stage I (CKD I), 46 with stage II (CKD II), 55 pregnant women with stage III (CKD III), 7 pregnant women with stage IV CKD (CKD IV), 6 pregnant women with end-stage CKD (CKD V) undergoing renal replacement therapy with hemodialysis. The key indicators of homeostasis have been identified on the basis of which dynamic monitoring should be carried out in this cohort of patients, and the effectiveness of the proposed management tactics has been proven. Results. The article substantiates the need for pregnancy planning in this group of women, presents the frequency of possible gestational complications, their prevention and treatment based on indicators of dynamic control of the main parameters of homeostasis developed for this contingent of patients. The criteria for predicting the outcome of pregnancy, conditions for prolongation of pregnancy in kidney diseases and medical indications for its artificial termination are presented, as well as methods of delivery are discussed. When using the proposed algorithm in patients with stages I and II of CKD, adverse pregnancy outcomes were absent, with stage III CKD, a 5-fold decrease in the total proportion of losses of desired pregnancies in all three trimesters was achieved (from 56.0 to 10.5%). In the group without this algorithm, the total proportion of losses in all trimesters of pregnancy corresponded to 49.4% in CKD I and 46.2% in CKD II. Conclusion. The presented algorithm for the management of pregnant women with CKD can significantly improve pregnancy outcomes in women with chronic kidney disease, even in the presence of chronic renal failure.

Objective. Improvement of early diagnosis of chronic kidney disease (CKD), improvement of its quality in case of reduced renal function in pregnant women by means of renal arteries Dopplerometry. Material and methods. A total of 283 pregnant women were included in the study. The 1st (control) group included 50 healthy pregnant women and the 2nd (main) group included 233 pregnant women with CKD. Pregnant women were distributed according to the stages of chronic kidney disease taking into account the rate of glomerular filtration into the following subgroups: 2A — stage I CKD (143 patients), 2B — stage II CKD (34 patients), 2C — stage III CKD (45 women), 2D — stage IV CKD (7 pregnant women), 2E — stage V CKD (4 patients). Dopplerometry of renal, segmental, interlobular, and interlobular arteries on both sides was performed at the following gestational periods: before 12 weeks; 13—21, 22—25, 26—28, 29—31, 32—34, 35—37, and 38—40 weeks. The following dopplerometric parameters were analyzed: peak systolic blood flow velocity (PSV), end-diastolic velocity (EDV), pulsatility index (PI), resistance index (IR), systolodiastolic ratio (S/D). Results. Measurement of peak systolic velocity in the interlobar arteries is the most informative. Pregnant women with CKD showed a decrease in PSV in the renal parenchyma vessels (interlobular vessels) on both sides, starting from stage I of CKD. In II and III trimesters of pregnancy, the separating values (cut-off thresholds) of PSV of the interlobar arteries were derived, with the help of which it was possible to differentiate the absence and presence of CKD in pregnant women in II and III trimesters, and in I, II, III trimesters — to differentiate chronic renal failure (CRF) from I and II stages of CKD. Conclusion. The most informative ultrasound marker of renal dysfunction in pregnant women is the maximum blood flow velocity in the interlobular arteries, which allows to determine the presence of CKD and differentiate CKD from CKD stages I and II.

Pregnancy in patients with chronic glomerulonephritis, especially complicated one, may contribute to the development of glomerulonephritis exacerbation or progressive deterioration of renal function. The differential diagnosis between pre-eclampsia and exacerbation or debut of glomerular pathology is difficult. There are no effective therapies for pre-eclampsia, but pre-eclampsia prophylaxis may be achieved with anticoagulants and antiaggregants. Data on the course of various forms of glomerulonephritis during pregnancy are often limited to single centers or small number of samples. The optimal approach to the management of women with chronic glomerulonephritis is planned pregnancy according to the recommendations of a multidisciplinary consilium, to achieve remission before conception, and to manage pregnancy and the postpartum period according to an individualized protocol. Further comprehensive studies of the complications and outcomes of pregnancy in chronic glomerulonephritis are required, and in clinical practice, combined monitoring of this group of pregnant women by an obstetrician-gynecologist, a nephrologist, and, if necessary, by physicians of other specialties is required.

Congenital and acquired vascular abnormalities of the uterus are quite rarely, but they are given much attention in the scientific literature due to the risk of life-threatening bleeding. In the uterus, as in any other organs, malformations can involve vessels of any caliber and type. The review summarizes the materials by clinical characteristics, pathogenesis, diagnostic methods, morphological features and management tactics of patients with uterine arteriovenous malformations. Enhanced myometrial vascularity in the puerperium due to retained placental tissue are also considered. The issues of terminology and differential diagnosis of these conditions are discussed, which is important in connection with significantly different approaches to treatment.