Pregnancy complicated by chronic renal disease

Regardless of the cause or degree of renal insufficiency, some common themes have run through the conclusions of many investigators studying chronic renal disease and pregnancy: fetal survival, once thought rare, now appears to be commonplace; maternal renal function, previously thought unlikely to survive a pregnancy, is not adversely affected in the majority of well-managed pregnancies, though the risk of deterioration is still considerable; of all the parameters that can be followed and influenced, maintenance of normotension is the most important. The improvements in maternal and fetal outcome clearly are due to improvements in postnatal care for the neonate, as well as an increased understanding of important risk factors leading to better antepartum maternal management. These women should all receive preconceptual counseling and optimization of their disease condition. Those choosing to become or continue pregnancy should receive their prenatal care from a team including perinatologists, nephrologists, and neonatologists. Only through a tightly coordinated, team approach can the meticulous care offering the opportunity for successful fetal outcome and minimization of maternal risk be provided.