Pregnancy with renal disease - Pathophysiology and anaesthetic management

Literature on anaesthetic management of pregnant women with renal disease is sparse due to uncommon association between chronic kidney disease and pregnancy. With better understanding and management of renal diseases and improved pregnancy outcomes in these patients, anaesthesiologists may increasingly encounter pregnant woman with acute or chronic kidney disease in the peripartum period for providing labour analgesia, anaesthesia for cesarean sections, for incidental surgeries or for critical care management. The current evidence on anaesthetic management of these patients consists of only case reports or series. A multidisciplinary team approach, preoperative optimization of systemic and biochemical abnormalities, preferential use of vasopressors rather than fluid boluses to maintain renal perfusion pressures, use of central neuraxial techniques in the absence of contraindications and vigilant postoperative monitoring can all contribute to a favourable peripartum outcome in these patients.