Bridging care: multidisciplinary approaches to kidney disease in pregnancy

The journey to motherhood is complex for individuals with kidney disease. Fertility progressively declines as kidney function worsens, particularly in patients with advanced chronic kidney disease and kidney failure. When pregnancy does occur, it often carries a high risk of significant potential complications for both mother and fetus. These risks are not limited to chronic conditions; patients with relapsing-remitting diseases such as some glomerular disorders, or those who experience acute kidney injury, also face considerable challenges during pregnancy. Chronic kidney disease is estimated to be present in 3%-4% of pregnancies and is associated with higher risk of preeclampsia, prematurity, and intrauterine growth restriction. The causes of acute kidney injury vary by trimester, with hyperemesis gravidarum in the first trimester, and preeclampsia, and thrombotic microangiopathies in later phases contributing to maternal and fetal morbidity. Pregnancy in kidney failure is less frequent because of diminished fertility and requires intensive dialysis protocols to optimize outcomes. Disease-specific outcomes depend on factors such as stage, comorbidities, and response to treatment. Physiological adaptations during pregnancy-such as increased glomerular filtration rate and renal plasma flow-complicate diagnosis and necessitate careful interpretation of biomarkers. Additional challenges arise from diseases such as lupus nephritis, focal segmental glomerulosclerosis, and IgA nephropathy, where immunosuppressive therapy must be carefully balanced to minimize maternal and fetal risk. Successful management of kidney disease in pregnancy requires early risk stratification, multidisciplinary care involving nephrologists and maternal-fetal medicine specialists, and individualized therapeutic strategies tailored to the stage of pregnancy and kidney disease. This review highlights current evidence on kidney disease in pregnancy, emphasizing recommendations for improving maternal and fetal health.