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2015, Número 1

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Rev Mex Traspl 2015; 4 (1)


Embarazo y trasplante renal

Izguerra-Ochoa LE, Renato-Parra M, Morales-Buenrostro LE

Idioma: Español
Referencias bibliográficas: 57
Paginas: 20-29
Archivo PDF: 347.31 Kb.


RESUMEN

Al igual que en el resto del mundo, en México la población con enfermedad renal crónica (ERC) y trasplante renal continúa creciendo. La fertilidad se ve afectada por la ERC, pero se recupera rápidamente después del trasplante en la mayoría de los casos en individuos en edad fértil. El embarazo implica cambios tanto anatómicos como funcionales en el riñón y representa riesgo de sensibilización sin que se haya demostrado aumento en los eventos de rechazo o pérdida de la función de los injertos, aunque sí implica incremento de complicaciones obstétricas como preeclampsia, diabetes gestacional, parto pretérmino y bajo peso al nacer. El nefrólogo, con el apoyo del médico de salud reproductiva, debe proponer un esquema de planificación familiar durante el primer año, determinar si las condiciones son óptimas y el tiempo ideal para llevar a cabo un embarazo, así como establecer medidas para reducir al mínimo las complicaciones materno-fetales. Al ser el principal objetivo del trasplante renal integrar al individuo a una vida funcional, es importante atender la fertilidad de la receptora de trasplante renal; sin embargo, la gestación en el contexto de trasplante está sujeta a un mayor riesgo de complicaciones tanto maternas como fetales, riesgos que la paciente y su pareja deben asumir. El nefrólogo juega un papel determinante al brindar información a la pareja y al tomar medidas para reducir riesgos materno-fetales. En la donadora renal parece claro que existe incremento del riesgo de trastornos hipertensivos del embarazo, sin que ello sea contraindicación para donar. Es responsabilidad del nefrólogo informar claramente dichos riesgos previos a la donación.


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