Renal disease and pregnancy

Women with renal disease should be counselled about the risks pregnancy may pose to them and their fetus before they conceive. Although worse baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised whether their medication needs to be modified, whether they are likely to suffer irreversible renal damage, and that they have a higher risk of pre-eclampsia with its attendant risks to the fetus. They need to consider the implications of the possibility of having a premature baby. Pregnancy-induced renal disease is less common and renal failure is 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 renal disease who present in pregnancy need to be assessed and a diagnosis made where possible. If their disease is relatively mild, they can be managed expectantly and monitored post partum. A key issue facing women who present in pregnancy is ensuring appropriate nephrological follow-up to ensure that a diagnosis is secured and a proper management plan is in place. Women with renal 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 renal expertise.