Chronic Kidney Disease and Pregnancy

Area of Science:

• Nephrology
• Obstetrics
• Reproductive Medicine

Background:

• Women with chronic kidney disease (CKD) experience increased risks for adverse pregnancy outcomes.
• These risks include CKD progression, disease flares, preeclampsia, and preterm delivery.
• Pregnancy management in CKD requires expertise across all disease stages, including end-stage kidney disease and dialysis.

Purpose of the Study:

• To review the physiological changes in pregnancy for women with CKD.
• To summarize maternal and fetal outcomes for pregnancies in women with varying stages of CKD.
• To discuss management strategies for hypertension and proteinuria in pregnant women with CKD.

Main Methods:

• Literature review of renal physiologic responses to pregnancy in CKD.
• Analysis of maternal and fetal outcomes in women with CKD at different stages.
• Discussion of management of complications and psychosocial aspects.

Main Results:

• Pregnancy in earlier-stage CKD is generally safer but carries risks.
• Even women with end-stage kidney disease have successfully conceived and carried pregnancies.
• Management involves addressing hypertension, proteinuria, and providing multidisciplinary support.

Conclusions:

• Nephrologists must be prepared to manage pregnancies at all stages of CKD.
• Multidisciplinary care is crucial for optimizing outcomes for mother and fetus.
• Addressing the emotional impact on young women with chronic disease is essential.