Pregnancy and the kidney

Abstract

Renal disease may occur de novo during pregnancy and pregnancy may occur in women with pre-existing renal disease. The chapters in this section consider the causes and implications of acute kidney injury that may occur during pregnancy and the likely outcomes of pregnancy in women with pre-existing chronic kidney disease, including the possible maternal and foetal complications of preterm delivery and pre-eclampsia (PET). There is a high incidence of PET in women with renal disease during pregnancy and importance of diagnosis and safe treatment of hypertension during pregnancy is discussed. The authors present the current theories of the pathogenesis of PET and highlight the importance of prophylactic treatment with aspirin to reduce the risk of PET. Pregnancy is increasingly common following renal transplantation and this group requires special consideration. They may have other concurrent medical conditions that need to be considered during pregnancy, or they may be at higher risk of other medical complications e.g. urinary tract infection with potential implications for maternal health and foetal wellbeing. It is important to facilitate preconception counselling for women with pre-existing renal disease to discuss optimal timing of pregnancy, make necessary adjustments to medications, and to discuss the likely outcomes for mother and baby. Managing renal disease during pregnancy requires the input of nephrologists, obstetricians, midwives, and often other healthcare professionals which is optimally delivered in a multi-disciplinary antenatal clinic with an expertise in this area.