Background Proteinuria is commonly measured to assess the renal status of chronic kidney disease (CKD) patients before the 20th week of gestation during pregnancy. The levels of proteinuria have been associated with adverse pregnancy outcomes. However, researchers have not clearly determined what baseline proteinuria levels would be associated with adverse pregnancy outcomes. This study aimed to analyse associations between proteinuria levels and adverse pregnancy outcomes among CKD patients treated with or without steroids/immunosuppressive therapy in early pregnancy. Methods This retrospective study included the clinical information of 557 pregnant patients with CKD from January 1, 2009, to December 31, 2021. A multivariable logistic regression analysis was conducted to evaluate the risk of adverse pregnancy outcomes across various proteinuria ranges, which were further stratified by whether the patients were receiving steroids/immunosuppressive therapy. Results (1) Proteinuria was assessed on twenty-four-hour urine collection. The median (quartile) baseline proteinuria levels were 0.83 g (0.20, 1.92) and 0.25 g (0.06, 0.80) in the steroids/immunosuppressive therapy and therapy-free groups, respectively. (2) CKD patients with adverse pregnancy outcomes had significantly higher proteinuria levels in the first trimester than patients without adverse pregnancy outcomes. (3) The risk of adverse pregnancy outcomes increased with increasing baseline proteinuria levels (P<0.001). (4) In the early-pregnancy steroids/immunosuppressive therapy group, the risk of severe preeclampsia was higher in patients with higher baseline proteinuria levels (P<0.007) (OR: 30.86 for proteinuria ≥5.00 g/24 h); In the therapy-free group, the risks of severe preeclampsia, very-low-birth-weight infants, early preterm birth and foetal–neonatal death were higher in patients with higher baseline proteinuria levels (P<0.001, P<0.001, P<0.001 and P = 0.006, respectively; OR: 53.16 for proteinuria ≥5.00 g/24 h; OR: 37.83 for proteinuria ≥5.00 g/24 h; OR: 15.30 for proteinuria ≥5.00 g/24 h; and OR: 18.83 for proteinuria ≥5.00 g/24 h, respectively). Conclusions As shown in the present study, a baseline 24-h proteinuria level exceeding 1.00 g was associated with adverse maternal outcomes. Furthermore, a 24-h proteinuria level greater than 2.00 g increased the incidence of adverse foetal events among CKD patients.

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24 小时蛋白尿水平与 CKD 女性不良妊娠结局相关

背景 通常在妊娠第 20 周之前测量蛋白尿来评估慢性肾脏病 (CKD) 患者的肾脏状况。蛋白尿水平与不良妊娠结局相关。然而，研究人员尚未明确确定什么基线蛋白尿水平与不良妊娠结局相关。本研究旨在分析妊娠早期接受或不接受类固醇/免疫抑制治疗的 CKD 患者的蛋白尿水平与不良妊娠结局之间的关联。方法回顾性研究2009年1月1日至2021年12月31日期间557例妊娠期CKD患者的临床信息。采用多变量Logistic回归分析评估不同蛋白尿范围内不良妊娠结局的风险，并进一步分层患者是否正在接受类固醇/免疫抑制治疗。结果 (1) 通过二十四小时尿液收集评估蛋白尿。类固醇/免疫抑制治疗组和未治疗组的中位（四分位数）基线蛋白尿水平分别为 0.83 g（0.20，1.92）和 0.25 g（0.06，0.80）。(2)有不良妊娠结局的CKD患者孕早期蛋白尿水平显着高于无不良妊娠结局的患者。(3)不良妊娠结局的风险随着基线蛋白尿水平的增加而增加(P<0.001)。（4）妊娠早期类固醇/免疫抑制治疗组中，基线蛋白尿水平较高的患者发生重度子痫前期的风险较高（P＜0.007）（蛋白尿≥5.00 g/24 h的OR为30.86）；在未治疗组中，基线蛋白尿水平较高的患者发生重度子痫前期、极低出生体重儿、早期早产和胎儿-新生儿死亡的风险较高（P<0.001、P<0.001、P<0.001）。分别为 0.001 和 P = 0.006；OR：蛋白尿≥5.00 g/24 h 为 53.16；OR：蛋白尿≥5.00 g/24 h 为 37.83；OR：蛋白尿≥5.00 g/24 h 为 15.30；OR：蛋白尿为 18.83分别≥5.00克/24小时）。结论 如本研究所示，基线 24 小时蛋白尿水平超过 1.00 g 与不良孕产妇结局相关。此外，24 小时蛋白尿水平大于 2.00 g 会增加 CKD 患者胎儿不良事件的发生率。