{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T07:50:17Z","timestamp":1762069817959,"version":"build-2065373602"},"reference-count":47,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Pregnancy with chronic kidney disease is challenging, and patients with diabetic nephropathy are at particular risk of a rapid kidney function decline during pregnancy. While indications for the management of pregnant patients with initial diabetic nephropathy are widely available in the literature, data on patients with severe nephrotic syndrome and kidney function impairment are lacking, and the decision on whether and when dialysis should be initiated is not univocal. We report a type 1 diabetes patient who started pregnancy with a severe nephrotic syndrome and shifted from CKD stage 3b to stage 5 during pregnancy. The management was complicated by a fetal heart malformation and by poorly controlled diabetes. The evidence for and against starting dialysis was carefully evaluated, and the choice of strict nephrological and obstetrical monitoring, nutritional management, and diuretic treatment made it possible to avoid dialysis in pregnancy, after ruling out pre-eclampsia. This experience enables examination of some open issues and contributes to the discussion of when to start dialysis in pregnancy.<\/jats:p>","DOI":"10.3390\/jcm11195725","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T01:51:49Z","timestamp":1664329909000},"page":"5725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Complex Management of Nephrotic Syndrome and Kidney Failure during Pregnancy in a Type 1 Diabetes Patient: A Challenging Case"],"prefix":"10.3390","volume":"11","author":[{"given":"Leo","family":"Drapeau","sequence":"first","affiliation":[{"name":"N\u00e9phrologie et Immunologie Clinique, CHU de Nantes, Nantes Universit\u00e9, 44000 Nantes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathilde","family":"Beaumier","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie, Centre Hospitalier Public du Cotentin, 50100 Cherbourg, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Esbelin","sequence":"additional","affiliation":[{"name":"Service de Gyn\u00e9cologie-Obst\u00e9trique, CHU de Nantes, 44000 Nantes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7ois","family":"Comoz","sequence":"additional","affiliation":[{"name":"Anatomie et Cytologie Pathologiques, CHU Caen Normandie, 14033 Caen, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucile","family":"Figueres","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie et Immunologie Clinique, CHU de Nantes, Nantes Universit\u00e9, 44000 Nantes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-4009","authenticated-orcid":false,"given":"Giorgina","family":"Piccoli","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie, Centre Hospitalier Le Mans, 72037 Le Mans, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8069-6105","authenticated-orcid":false,"given":"Delphine","family":"Kervella","sequence":"additional","affiliation":[{"name":"Center for Research in Transplantation and Translational Immunology, UMR 1064, ITUN, Inserm, CHU de Nantes, Nantes Universit\u00e9, F-44000 Nantes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2044","DOI":"10.1111\/dme.13923","article-title":"An Irish National Diabetes in Pregnancy Audit: Aiming for best outcomes for women with diabetes","volume":"37","author":"Egan","year":"2020","journal-title":"Diabet. 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