Renal Disease

Abstract

Renal disease can lead to significant complications during pregnancy, both for mother and child, and must be managed appropriately and efficiently. Recommended intervention depends on the severity and the underlying cause, as well as the acute versus chronic nature of the disease, and should involve optimization both prior to and during pregnancy. With suboptimal treatment, chronic kidney disease can progress to end-stage renal disease necessitating dialysis. Furthermore, renal disease has a negative effect on the fetus including an increase in the risk of intrauterine growth restriction, preterm delivery, and fetal loss. Urolithiasis and pyelonephritis are not uncommon in pregnancy and require special attention. The diagnosis of urolithiasis is complicated, as ultrasonography is the safest modality for the developing fetus but is also associated with a substantial false-negative rate. Although the majority of stones will pass without intervention, some may require the placement of ureteral stents or manual extraction. It is unclear whether urolithiasis itself has a negative impact on pregnancy, as the data are conflicting; however, pyelonephritis has been shown to cause an increase in delivering a fetus with low birth weight and spontaneous preterm birth. Therefore, all urinary tract infections are treated aggressively during pregnancy. This review contains 5 figures, 6 tables, and 43 references. Key Words: acute kidney injury, chronic kidney disease, dialysis, end-stage renal disease, lupus nephritis, pyelonephritis, renal transplant, urolithiasis