{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T01:52:34Z","timestamp":1782525154191,"version":"3.54.5"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T00:00:00Z","timestamp":1671667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Research Grant","award":["NFRCH22-0011"],"award-info":[{"award-number":["NFRCH22-0011"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aimed to evaluate the differences in the impact on maternal renal function between singleton and twin pregnancies in the second half of pregnancy. It retrospectively enrolled 1711 pregnant women consisting of 1547 singleton pregnancies and 164 twin pregnancies from Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital from January 2019 to June 2021. Patients underwent renal function tests (serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) at least one month before delivery. The main outcome measure was maternal renal dysfunction, defined as a serum creatinine level above 0.8 mg\/dL. The serum creatinine level was significantly higher and the eGFR was significantly lower in twin than in singleton pregnancies (p &lt; 0.001). In addition, the rate of renal dysfunction was significantly higher in twin than in singleton pregnancies (7.9% vs. 2.6%; p &lt; 0.01). Multivariate analysis revealed that twin pregnancy (odds ratio (OR) 3.38), nulliparity (OR 2.31), and preeclampsia (OR 3.64) were significant risk factors for maternal renal dysfunction. Maternal renal dysfunction was observed in 13 twin pregnancies, all of which recovered to within normal limits during the early months of the postpartum period. Twin pregnancy is a significant risk factor for maternal renal dysfunction; renal function should be carefully monitored in twin pregnancies.<\/jats:p>","DOI":"10.3390\/jcm12010090","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T03:26:25Z","timestamp":1671765985000},"page":"90","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Maternal Renal Dysfunction in Late Pregnancy in Twin and Singleton Pregnancies: Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Aki","family":"Minoda","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Tsuda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiki","family":"Masahashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuto","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miho","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiko","family":"Fukuhara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumiko","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuko","family":"Tezuka","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Ando","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimio","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya 453-8511, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Vinturache, A., Popoola, J., and Watt-Coote, I. (2019). The Changing Landscape of Acute Kidney Injury in Pregnancy from an Obstetrics Perspective. J. Clin. Med., 8.","DOI":"10.3390\/jcm8091396"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"F199","DOI":"10.1152\/ajprenal.00018.2017","article-title":"Adaptive changes in GFR, tubular morphology, and transport in subtotal nephrectomized kidneys: Modeling and analysis","volume":"313","author":"Layton","year":"2017","journal-title":"Am. J. Physiol. Renal. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1038\/ki.1980.124","article-title":"Renal hemodynamics and tubular function normal human pregnancy","volume":"18","author":"Davison","year":"1980","journal-title":"Kidney Int."},{"key":"ref_4","unstructured":"Cunningham, F.G., Leveno, K.J., Bloom, S.L., Dashe, J.S., Hoffman, B.L., Casey, B.M., and Spong, C.Y. (2018). Maternal physiology. Williams Obstetrics, McGraw-Hill. [25th ed.]."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1001\/jama.2018.17948","article-title":"Serum creatinine levels Before, During, and After pregnancy","volume":"321","author":"Harel","year":"2019","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/S0272-6386(12)81111-5","article-title":"Renal hemodynamics in normal and hypertensive pregnancy: Lessons from micropuncture","volume":"17","author":"Baylis","year":"1991","journal-title":"Am. J. Kidney Dis."},{"key":"ref_7","unstructured":"Taylor, R.N., Roberts, J.M., and Cunningham, F.G. (2014). The kidney in normal pregnancy and preeclampsia. Chesley\u2019s Hypertensive Disorders in Pregnancy, Academic Press. [4th ed.]."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1053\/j.ackd.2020.07.006","article-title":"Kidney physiology in pregnancy","volume":"27","author":"Beers","year":"2020","journal-title":"Adv. Chronic. Kidney Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"H745","DOI":"10.1152\/ajpheart.00861.2008","article-title":"Increased vascular angiotensin type 2 receptor expression and NOS-mediated mechanisms of vascular relaxation in pregnant rats","volume":"296","author":"Stennett","year":"2009","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1172\/JCI118059","article-title":"Acute blockade of nitric oxide synthase inhibits renal vasodilation and hyperfiltration during pregnancy in chronically instrumented conscious rats","volume":"96","author":"Danielson","year":"1995","journal-title":"J. Clin. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"F592","DOI":"10.1152\/ajprenal.2001.280.4.F592","article-title":"Chronic NOS inhibition reverses systemic vasodilation and glomerular hyperfiltration in pregnancy","volume":"280","author":"Cadnapaphornchai","year":"2001","journal-title":"Am. J. Physiol. Renal. Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.2215\/CJN.00470112","article-title":"Obstetric nephrology: Renal hemodynamic and metabolic physiology in normal pregnancy","volume":"7","author":"Odutayo","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1053\/ajkd.2002.30561","article-title":"Changes in urinary excretion of six biochemical parameters in normotensive pregnancy and preeclampsia","volume":"39","author":"Hayashi","year":"2002","journal-title":"Am. J. Kidney Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e046616","DOI":"10.1136\/bmjopen-2020-046616","article-title":"Evaluation of the risk of umbilical cord prolapse in the second twin during vaginal delivery: A retrospective cohort study","volume":"11","author":"Asahina","year":"2021","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.14390\/jsshp.HRP2018-014","article-title":"Outline of the new definition and classification of \u201cHypertensive Disorders of Pregnancy (HDP)\u201d; a revised JSSHP statement of 2005","volume":"6","author":"Watanabe","year":"2018","journal-title":"Hypertens Res. Pregnancy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0020-7292(99)00226-X","article-title":"Prenatal detection of a high-risk group for intrauterine growth restriction based on sonographic fetal biometry","volume":"68","author":"Yoshida","year":"2000","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1177\/1470320310376986","article-title":"The midgestational maternal blood pressure decline is absent in mice lacking expression of the angiotensin II AT2 receptor","volume":"12","author":"Carey","year":"2011","journal-title":"J. Renin. Angiotensin Aldosterone Syst."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/bph.13614","article-title":"Vascular actions of relaxin: Nitric oxide and beyond","volume":"174","author":"Leo","year":"2017","journal-title":"Br. J. Pharmacol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3109\/00016349209021070","article-title":"Microalbuminuria as a predictor of preeclampsia","volume":"71","author":"Hesseldahl","year":"1992","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/AOG.0000000000000383","article-title":"Maternal proteinuria in twin compared with singleton pregnancies","volume":"124","author":"Osmundson","year":"2014","journal-title":"Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.3109\/14767058.2013.879699","article-title":"Twin pregnancy after kidney transplantation: What\u2019s on? A case report and review of literature","volume":"27","author":"Gizzo","year":"2014","journal-title":"J. Matern. Fetal Neonatal. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1590\/2175-8239-jbn-2020-0016","article-title":"Twin pregnancy after kidney transplantation: Case report and systematic review","volume":"43","author":"Sousa","year":"2021","journal-title":"J. Bras Nefrol."},{"key":"ref_23","first-page":"806","article-title":"Maternal cardiac function in twin pregnancy","volume":"102","author":"Kametas","year":"2003","journal-title":"Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1111\/j.1471-0528.2009.02353.x","article-title":"The haemodynamic, renal excretory and hormonal changes induced by resting in the left lateral position in normal pregnant women during late gestation","volume":"116","author":"Almeida","year":"2009","journal-title":"BJOG"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3892\/etm.2021.10949","article-title":"Early diagnosis and management of maternal ureterohydronephrosis during pregnancy","volume":"23","author":"Ciciu","year":"2022","journal-title":"Exp. Ther. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/00003081-198528020-00002","article-title":"Morphologic changes in the renal tract in pregnancy","volume":"28","author":"Beydoun","year":"1985","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/0002-9378(79)90738-5","article-title":"Hydronephrosis of pregnancy: Ultrasonographic study and classification of asymptomatic women","volume":"135","author":"Fried","year":"1979","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/S0002-9378(97)70223-0","article-title":"Acute renal failure in the first trimester resulting from uterine leiomyomas","volume":"177","author":"Courban","year":"1997","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0272-6386(12)80103-X","article-title":"Obstructive acute renal failure by a gravid uterus: A case report and review","volume":"18","author":"Brandes","year":"1991","journal-title":"Am. J. Kidney Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1681\/ASN.2019060605","article-title":"Estimating urine albumin-to-creatinine ratio from protein-to-creatinine ratio: Development of equations using same-day measurements","volume":"31","author":"Weaver","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/j.1471-0528.2007.01621.x","article-title":"Comparison of methods to identify significant proteinuria in pregnancy in the outpatient setting","volume":"115","author":"Kyle","year":"2008","journal-title":"BJOG"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ijgo.2009.05.023","article-title":"Comparison of pregnancy outcomes in women with hypertensive disorders of pregnancy using 24-hour urinary protein and urinary microalbumin to creatinine ratio","volume":"107","author":"Gangaram","year":"2009","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1056\/NEJMra2201153","article-title":"Uses of GFR and albuminuria level in acute and chronic kidney disease","volume":"386","author":"Levey","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.rvsc.2018.12.016","article-title":"Circulating electrolytes in the bloodstream of transition Sarda goats make the difference in body fluid distribution between single vs. twin gestation","volume":"123","author":"Cappai","year":"2019","journal-title":"Res. Vet. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1002\/uog.20137","article-title":"Maternal kidney function during pregnancy: Systematic review and meta-analysis","volume":"54","author":"Spaan","year":"2019","journal-title":"Ultrasound. Obstet. Gynecol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/1\/90\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:18Z","timestamp":1760147298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/1\/90"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,22]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12010090"],"URL":"https:\/\/doi.org\/10.3390\/jcm12010090","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,22]]}}}