INFLUENCE OF PREGNANCY ON PROGRESSION OF DIABETIC NEPHROPATHY AND SUBSEQUENT REQUIREMENT OF RENAL REPLACEMENT THERAPY IN FEMALE TYPE-I DIABETIC-PATIENTS WITH IMPAIRED RENAL-FUNCTION

The influence of pregnancy on the progression of diabetic nephropathy in diabetic women with pre-existing moderate renal insufficiency is a subject of considerable controversy in the literature. In four of five female patients with type I diabetes mellitus with pre-existing impai red renal function (creatinine clearance < 80 ml/min), significant pro teinuria (> 2 g/24 h urine) and hypertension we have found a further d ecline in renal function during pregnancy, with an increased deteriora tion rate of creatinine clearance in comparison to the time before and after pregnancy. The mean decline of the glomerular filtration rate w as 1.8 ml/min per month during pregnancy and 1.4 ml/min per month post partum until the start of dialysis treatment. The difference in the pr ogression of diabetic nephropathy during and after pregnancy can be ex plained by increased hypertension during pregnancy, especially in the third trimester, despite an intensified antihypertensive therapy. The longterm effect of pregnancy on renal function in our patients was the refore an earlier requirement for renal replacement therapy than would have been expected without pregnancy.