{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:11:33Z","timestamp":1779145893727,"version":"3.51.4"},"reference-count":59,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,1,20]],"date-time":"2019-01-20T00:00:00Z","timestamp":1547942400000},"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 is increasingly reported in chronic kidney disease (CKD), reflecting higher awareness, improvements in materno-foetal care, and a more flexible attitude towards \u201callowing\u201d pregnancy in the advanced stages of CKD. Success is not devoid of problems and an important grey area regards the indications for starting dialysis (by urea level, clinical picture, and residual glomerular filtration rate) and for dietary management. The present case may highlight the role of plant-based diets in dietary management in pregnant CKD women, aimed at retarding dialysis needs. The case. A 28-year-old woman, affected by glomerulocystic disease and unilateral renal agenesis, in stage-4 CKD, was referred at the 6th week of amenorrhea: she weighed 40 kg (BMI 16.3), was normotensive, had no sign of oedema, her serum creatinine was 2.73 mg\/dL, blood urea nitrogen (BUN) 35 mg\/dL, and proteinuria 200 mg\/24 h. She had been on a moderately protein-restricted diet (about 0.8 g\/kg\/real body weight, 0.6 per ideal body weight) since childhood. Low-dose acetylsalicylate was added, and a first attempt to switch to a protein-restricted supplemented plant-based diet was made and soon stopped, as she did not tolerate ketoacid and aminoacid supplementation. At 22 weeks of pregnancy, creatinine was increased (3.17 mg\/dL, BUN 42 mg\/dL), dietary management was re-discussed and a plant-based non-supplemented diet was started. The diet was associated with a rapid decrease in serum urea and creatinine; this favourable effect was maintained up to the 33rd gestational week when a new rise in urea and creatinine was observed, together with signs of cholestasis. After induction, at 33 weeks + 6 days, she delivered a healthy female baby, adequate for gestational age (39th centile). Urea levels decreased after delivery, but increased again when the mother resumed her usual mixed-protein diet. At the child\u2019s most recent follow-up visit (age 4 months), development was normal, with normal weight and height (50th\u201375th centile). In summary, the present case confirms that a moderate protein-restricted diet can be prescribed in pregnancies in advanced CKD without negatively influencing foetal growth, supporting the importance of choosing a plant-based protein source, and suggests focusing on the diet\u2019s effects on microcirculation to explain these favourable results.<\/jats:p>","DOI":"10.3390\/jcm8010123","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T03:08:22Z","timestamp":1548126502000},"page":"123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Dialysis or a Plant-Based Diet in Advanced CKD in Pregnancy? A Case Report and Critical Appraisal of the Literature"],"prefix":"10.3390","volume":"8","author":[{"given":"Rossella","family":"Attini","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedetta","family":"Montersino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filomena","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fosca","family":"Minelli","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8650-583X","authenticated-orcid":false,"given":"Federica","family":"Fassio","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maura Maria","family":"Rossetti","sequence":"additional","affiliation":[{"name":"SCDU Nephrology, Citt\u00e0 della Salute e della Scienza, University of Torino, 10100 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loredana","family":"Colla","sequence":"additional","affiliation":[{"name":"SCDU Nephrology, Citt\u00e0 della Salute e della Scienza, University of Torino, 10100 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5243-0940","authenticated-orcid":false,"given":"Bianca","family":"Masturzo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Barreca","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, University of Torino, 10100 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Menato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology SC2U, Citt\u00e0 della Salute e della Scienza-O.I.R.M., Sant\u2019Anna Hospital, 10100 Turin, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-4009","authenticated-orcid":false,"given":"Giorgina Barbara","family":"Piccoli","sequence":"additional","affiliation":[{"name":"Department of Biological and Clinical Sciences, University of Torino, 10100 Torino, Italy"},{"name":"Nephrology, Centre Hospitalier Le Mans, 72000 Le Mans, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1136\/bmj.39406.652986.BE","article-title":"Chronic kidney disease in pregnancy","volume":"336","author":"Williams","year":"2008","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.semnephrol.2010.10.008","article-title":"Pregnancy and chronic kidney disease","volume":"31","author":"Davison","year":"2011","journal-title":"Semin. 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