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Kidney disease can cause complications in pregnancy, and pregnancy can cause complications in women with kidney disease, and pregnancy can itself cause renal impairment.
Women with pre-existing kidney disease should discuss the risks with their kidney specialist before trying to conceive. There is good evidence to suggest that women with very mild kidney disease (stages 1-2), normal blood pressure and little or no proteinuria can have a healthy pregnancy. In women with moderate to severe kidney disease (stages 3-5), the risk of complications is much greater, and for some women the risk to both the mother and baby are so high that pregnancy should be avoided.
In pregnancy, glomerular filtration rate increases to up 150 per cent of the non-pregnant rate, and levels of urea and creatinine are decreased. Values which are considered normal in non-pregnant women may indicate decreased renal function in pregnancy. Creatinine above 75 ?mol/l and urea >4.5 mmol/l should prompt further investigation. Estimated glomerular filtration rate (eGFR) is not recommended in pregnancy. Glycosuria is common in pregnancy and does not necessarily indicate diabetes or impaired glucose tolerance. In the absence of infection women with proteinuria greater than +1 on dipstick testing should have their level of proteinuria quantified (24-hour urine collection). Persistent proteinuria >500mg/day before 20 weeks gestation should be referred promptly to a kidney specialist.
Asymptomatic urinary tract infection (UTI) and bacteriuria should be treated with antibiotics to reduce the risk of pyelonephritis, intrauterine growth restriction, fetal death and preterm labour.
Kidney disease can present for the first time during pregnancy, and women suspected to have kidney disease should be referred to a kidney specialist.
National Kidney Foundation (2016) Pregnancy and kidney disease. Available at: https://www.kidney.org/atoz/content/pregnancy
Medscape (2015). Renal disease and pregnancy. http://emedicine.medscape.com/article/246123-overview
Henderson R. (2014) Renal disease in Pregnancy (Professional reference). Available at: http://patient.info/doctor/renal-disease-in-pregnancy