J Urol Ren Dis, an open access journal ISSN: 2575-7903 1 Volume 11; Issue 02 Journal of Urology and Renal Diseases Opinion Facca TA, et al. J Urol Ren Dis 11: 1149. Pregnancy may be an Opportunity to Diagnose Kidney Disease Thaís Alquezar Facca 1* , Amélia Rodrigues Pereira Sabino 1 , Michelle Tiveron Passos 1 , Sonia Kiyomi Nishida 1 , Silvia Regina Mor- eira 1 , Eduardo Augusto Brosco Famá 1 , Nelson Sass 2 , Gianna Mastroianni-Kirsztajn 1 1 Department of Medicine, Divisions of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil 2 Department and Division of Obstetrics, Federal University of Sao Paulo, São Paulo, Brazil * Corresponding author: Thaís Alquezar Facca, 1Department of Medicine, Divisions of Nephrology, Federal University of Sao Paulo, São Paulo, Brazil. Tel: +55-1159041699; Email: tafacca@hotmail.com Citation: Facca TA, Sabino ARP, Passos MT, Nishida SK, Moreira SR, et al. (2019) Pregnancy may be an Opportunity to Diagnose Kidney Disease. J Urol Ren Dis 11: 1149. DOI: 10.29011/2575-7903.001149 Received Date: 10 June, 2019; Accepted Date: 17 June, 2019; Published Date: 21 June, 2019 DOI: 10.29011/2575-7903.001149 Abstract During pregnancy there is a renal adaptation that can interfere in glomerular physiology and the manifestation or exac- erbation of glomerulopathies may be the result of this period. Women diagnosed with glomerulopathies who become pregnant are not only subject to worse fetal and maternal prognosis, but also to develop long-term chronic kidney disease resulting from some obstetric complications. There is a shortage of studies that contribute to optimize medical follow-up with nephrologists and obstetricians from preconception to the postpartum period, contributing to early diagnosis and preventing the progression of renal dysfunction. Keywords: Glomerulonephritis; High-Risk; Kidney diseases; Preconception care; Pregnancy outcome; Pregnancy Introduction Since the beginning of pregnancy the maternal urinary system undergoes some functional and anatomical adaptations, such as the increase of glomerular fltration rate, low systemic vascular resistance and thus, decrease of serum creatinine and urea levels [1]. Another alteration found in normal pregnancy is the increase of urinary excretion of proteins, which is mostly Tamm-Horsfall; however, proteinuria, such as albuminuria, at high levels seems to be the main cause of renal disease progression in this period especially when associated with pre-eclampsia. This relationship is similar to that in type 1 diabetes mellitus and may be directly associated with adverse maternal and perinatal outcomes [2]. In the long term, there is also an increased risk of women who had pre-eclampsia have persistent proteinuria after delivery, perhaps this may be related to the coexistence of not previously diagnosed glomerulopathy [3]. Women who become pregnant with pre- diagnosed glomerulopathy and normal renal function appear to have no worsening of the kidney disease after childbirth in most cases, different from that observed in those who have become pregnant with moderate or severe kidney defcit that often have deterioration of renal function after pregnancy, especially when associated with high blood pressure and proteinuria [4]. The follow-up of women with glomerulopathies who become pregnant is diffcult for both the nephrologist and the obstetrician, not only because it is a high-risk pregnancy, but also because of the scarcity of information in the literature and the diversity of diseases that may be involved. Discussion Pregnancy associated with kidney disease requires differentiated medical care, especially when the disease is already in advanced stages due to the risk of a worse maternal- fetal outcome [5]. Preconception counseling and nephrological assessment months before pregnancy can optimize the course of pregnancy and renal function, so the multidisciplinary follow-up of women with glomerulopathies who intend to become pregnant is as important as of those who have already become pregnant [6]. There is no doubt that studies in the literature can contribute to a better understanding of the course of glomerulopathies in pregnancy and how to manage it. It is remarkable that most of them describe adverse pregnancy outcomes as shown below. A retrospective study of 80 pregnant women with chronic kidney disease found renal function impairment after pregnancy and higher incidence of pre-eclampsia, anemia and fetal complications in the advanced stages of the kidney disease [7]. Another retrospective study of 238 women with glomeropathies and who became pregnant showed high perinatal mortality, especially in those who had renal function deterioration, high blood pressure or nephrotic syndrome [8]. A retrospective