Renal disease and pregnancy

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 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 post pre-eclampsia. Women with renal disease that present in pregnancy need to be assessed and a diagnosis made where possible. If their disease is relatively mild then 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 diagnosis is secured and a proper management plan in place. Women with renal disease must generally be considered as having high risk pregnancies and need to be aware of this and be managed in a centre with appropriate obstetric and renal expertise.