Chronic Renal Disease in Pregnancy

Abstract

The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. It appears that chronic renal disease in pregnancy is uncommon, occurring in 0.03-0.12% of all pregnancies from two U.S. population-based and registry studies. Maternal complications associated with chronic renal disease include preeclampsia, worsening renal function, preterm delivery, anemia, chronic hypertension, and cesarean delivery. The live birth rate in women with chronic renal disease ranges between 64% and 98% depending on the severity of renal insufficiency and presence of hypertension. Significant proteinuria may be an indicator of underlying renal insufficiency. Management of pregnant women with underlying renal disease should ideally entail a multidisciplinary approach at a tertiary center and include a maternal-fetal medicine specialist and a nephrologist. Such women should receive counseling regarding the pregnancy outcomes in association with maternal chronic renal disease and the effect of pregnancy on renal function, especially within the ensuing 5 years postpartum. These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).

Parity and Kidney Cancer Risk: Evidence from Epidemiologic Studies

“…Renal tubular cells and vascular bed may be more vulnerable to inflammation or oxidative stress through pregnancy-induced physiologic changes such as increases in maternal blood volume, cardiac output, renal plasma flow, glomerular filtration, kidney size, dilation of the renal pelvis, and excess risk of urinary tract infection (7,40,41). Anatomic change in the kidney during pregnancy might also contribute to the oxidative stress and inflammation of the nephrons (7,40). In addition, hormones, either directly or through growth factors, may act as promoters of malignant changes by stimulating renal cell proliferation (42).…”

“…Animal studies have demonstrated that estrogens can promote or induce kidney cancer development (6). Fluctuating sex hormones have also been shown to make nephrons vulnerable to inflammation and oxidative stress (7).…”

Pregnancy in an Intestinal Transplant Recipient

“…8 Our patient, however, had chronic renal insufficiency manifested by elevated creatinine level known to be associated with preeclampsia, fetal growth restriction, and stillbirth. 9 Breastfeeding is associated with many benefits to the newborn and mother, and this was encouraged in the current case. Although other reports describe a wide range of fetal immunosuppressant levels, the newborn's blood level was low and our patient successfully breastfed for several weeks.…”

Obstetric Nephrology

“…The risk for progression is determined in part by the severity of the underlying renal disease and is increased for patients with creatinine values .1.4 mg/dl (33). Underlying renal disease, in turn, places these pregnancies at higher risk for maternal and fetal complications, including spontaneous abortion, premature delivery, intrauterine growth retardation, and pre-eclampsia (35).…”