Renal disease in pregnancy

Women with kidney disease who become pregnant are at risk of further damage to their kidneys and an adverse pregnancy outcome. In general, women with mild renal dysfunction (Scr<125 μmol/litre) usually pass through pregnancy without adverse impact on their kidneys, although complications such as pre-eclampsia, fetal growth restriction and pre-term delivery are more likely. Women with severe renal impairment (Scr >220 mmol/litre) have a 1:3 risk of an accelerated decline in renal function because of pregnancy and pre-eclampsia, fetal growth restriction and pre-term delivery become common place. Clinical features such as pre-existing hypertension, proteinuria >1 g/24 hour and/or urinary tract infections add to the likelihood of complications. This article discusses important issues for women with kidney disease in pregnancy.