Chapter 66 - Pregnancy and Chronic Kidney Disease

Abstract

CKD affects almost 4% of women of childbearing age (20–39 years). With the increasing incidence of CKD in the general population, and the trend to delay childbirth to more advanced maternal ages, the incidence of CKD in pregnancy is likely to increase in the future. In women with early stage CKD (S[Cr] less than 1.4mg/dL) and well-controlled blood pressure, the likelihood of successful pregnancy is high and of pregnancy-associated deterioration in kidney function is low. Nevertheless, CKD is associated with several adverse maternal and neonatal outcomes, including pre-eclampsia, intrauterine growth restriction, and preterm delivery. Pregnancy in more advanced CKD (S[Cr] greater than 2.0mg/dL) can result in an accelerated and often irreversible decline in renal function. CKD can present de novo during pregnancy. Management and outcomes must be individualized based on the severity, etiology, and gestational age at presentation. Medical management of kidney disease and its complications during pregnancy is affected by the impact of therapy on the developing fetus.