Pregnancy in Chronic Kidney Disease: Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Different CKD Stages and Phases

Pregnancy is possible in all phases of chronic kidney disease (CKD), but its management may be difficult and the outcomes are not the same as in the overall population. The prevalence of CKD in pregnancy is estimated at about 3%, as high as that of pre-eclampsia (PE), a better-acknowledged risk for adverse pregnancy outcomes. When CKD is known, pregnancy should be considered as high risk and followed accordingly; furthermore, since CKD is often asymptomatic, pregnant women should be screened for the presence of CKD, allowing better management of pregnancy, and timely treatment after pregnancy. The differential diagnosis between CKD and PE is sometimes difficult, but making it may be important for pregnancy management. Pregnancy is possible, even if at high risk for complications, including preterm delivery and intrauterine growth restriction, superimposed PE, and pregnancy-induced hypertension. Results in all phases are strictly dependent upon the socio-sanitary system and the availability of renal and obstetric care and, especially for preterm children, of intensive care units. Women on dialysis should be aware of the possibility of conceiving and having a successful pregnancy, and intensive dialysis (up to daily, long-hours dialysis) is the clinical choice allowing the best results. Such a choice may, however, need adaptation where access to dialysis is limited or distances are prohibitive. After kidney transplantation, pregnancies should be followed up with great attention, to minimize the risks for mother, child, and for the graft. A research agenda supporting international comparisons is highly needed to ameliorate or provide knowledge on specific kidney diseases and to develop context-adapted treatment strategies to improve pregnancy outcomes in CKD women

Étude de la permittivité du sel de seignette en présence d'un champ électrique en forme de créneaux

A study of the complex permittivity of Rochelle salt subjected to an electric field in square wave shape being unidirectional positive and negative has been performed at 0 °C with a measurement-signal at 480 kHz. A speed displacement of the domain walls is deduced for a determined value of the electric field. During these measurements, we have observed an assymmetry of values of ε' for the same value of the following field which was positive or negative. This assymmetry is connected with the electrostatic attraction of condenser plates and with the piezoelectricity of Rochelle salt.Une étude de la permittivité complexe du sel de Seignette soumis à un champ électrique en forme de créneaux unidirectionnels positifs et négatifs a été effectuée à 0 °C au moyen d'un signal de mesure à 480 kHz. Une vitesse de déplacement des murs de domaines en est déduite pour une valeur déterminée du champ électrique. Pendant ces mesures, on a observé une dissymétrie des valeurs de ε' pour la même valeur du champ suivant qu'il était positif ou négatif. On en donne une explication en tenant compte de l'attraction électrostatique des armatures du condensateur et de la piézoélectricité du sel de Seignette