Kidney disease and pregnancy

Women with kidney disease should be counselled about the risks pregnancy may pose to mother and fetus before they conceive. Although impaired baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised that they may suffer irreversible kidney damage, may well need to change their medications in advance of pregnancy and face a higher risk of pre-eclampsia with its attendant risks to the fetus. They need to consider the implications of having a premature baby. Compared with the probability that pregnancy will exacerbate existing kidney disease, pregnancy-induced kidney disease in women with previously normal renal function is less common and kidney failure rare. The commonest causes are those associated with severe pre-eclampsia and are usually managed by early delivery. Proteinuria can persist for months after pre-eclampsia. Women with kidney disease who present in pregnancy should be assessed and a diagnosis made where possible. If their disease is relatively mild, they can be managed expectantly and monitored post partum. Arrangements for appropriate renal follow-up should be made for all women who present in pregnancy, to ensure that a diagnosis is secured and a proper management plan is in place. Women with kidney disease must generally be considered as having high-risk pregnancies; they need to be aware of this and to be managed in a centre with appropriate obstetric and kidney expertise.