[Kidneys; hypertension and pregnancy. III. The renal risk in pregnancy]

When a woman with chronic renal disease wishes to become pregnant, the risk to the mother and the foetus is often inaccurately evaluated or exaggerated. In patients with primary nephropathy the foetal risk is significantly increased by the arterial hypertension frequently associated with renal insufficiency. In systemic lupus erythematosus (SLE) with renal involvement, the risk represented by hypertension is compounded by a high incidence of spontaneous abortion, particularly when the disease is progressive. Pregnancy seems to have little influence on SLE itself, and the classical post-partum problems are controversial. Much more dangerous are acute complications, such as cortical necrosis or haemolytic and uraemic syndromes occurring in apparently healthy women during the last trimester of pregnancy and after delivery. Urinary infections are common during pregnancy. They are heralded by asymptomatic bacteriuria which should be systematically detected, since these infections increase the likelihood of pyelonephritis with in turn increases the severity of perinatal complications.