Anesthetic Management of the Pregnant Patient with Renal Disease

  • Gulay Ok


Pregnancy leads to reversible anatomical and physiological changes in the renal system. The severity of kidney disease, biochemical tests of the pregnant woman, and accompanying comorbidities serve as guidelines in determining the anesthesia technique. Type of anesthesia to be performed in pregnancies with acute renal failure is different from pregnancies with chronic renal failure.

Nephrologists, anesthesiologists, and obstetricians should evaluate these cases with a multidisciplinary approach. Aspiration prophylaxis should always be performed in patients with chronic renal failure. If general anesthesia is to be administered, drugs with short duration of action and having elimination independent from the kidney (atracurium/cisatracurium, remifentanil, etc.) should be preferred. Neuraxial anesthesia is a good choice if there is no coagulopathy, thrombocytopenia, and platelet dysfunction. Invasive hemodynamic monitoring and vasopressors (phenylephrine or ephedrine) should be readily available to maintain renal perfusion during neuraxial anesthesia in major renal operations of complicated parturients.


Acute renal failure Pregnancy Chronic renal failure Hemodialysis Anesthesia 


  1. 1.
    Bajwa SJ, Kwatra IS, Bajwa SK, Kaur M. Renal diseases during pregnancy: critical and current perspectives. J Obstet Anesth Crit Care. 2013;3(1):7–15.CrossRefGoogle Scholar
  2. 2.
    Baylis C. Impact of pregnancy on underlying renal disease. Adv Ren Replace Ther. 2003;10:31–9.CrossRefGoogle Scholar
  3. 3.
    Cheung KL, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013;20(3):209–14.CrossRefGoogle Scholar
  4. 4.
    Baidya DK, Maitra S, Chhabra A, Mishra R. Pregnancy with renal disease-pathophysiology and anaesthetic management. Trends Anaesth Crit Care. 2012;2(6):281–6.CrossRefGoogle Scholar
  5. 5.
    Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Compr Physiol. 2012;2(2):1303–53.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Reid RW. Renal disease. In: Chestnut David M, editor. Obstetric anaesthesia principles and practice. 3rd ed. Amsterdam: Elsevier; 2004. p. 904–13.Google Scholar
  7. 7.
    Sahay M. Acute kidney injury in pregnancy. In:Basic nephrology and acute kidney injury; 2012. p. 151–72.CrossRefGoogle Scholar
  8. 8.
    Fischer MJ, Lehnerz SD, Hebert JR, et al. Kidney disease is an independent risk factor for adverse fetal and maternal outcomes in pregnancy. Am J Kidney Dis. 2004;43:415–23.CrossRefGoogle Scholar
  9. 9.
    Karumanchi SA, Maynard SE, Stillman IE, et al. Preeclampsia: a renal perspective. Kidney Int. 2005;67:2101–13.CrossRefGoogle Scholar
  10. 10.
    Moran P, Baylis PH, Lindheimer MD, et al. Glomerular ultrafiltration in normal and preeclamptic pregnancy. J Am Soc Nephrol. 2003;14:648–52.CrossRefGoogle Scholar
  11. 11.
    Mirza FG, Cleary KL. Pre-eclampsia and the kidney. Semin Perinatol. 2009;33(3):173–8.CrossRefGoogle Scholar
  12. 12.
    Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: obstetric and anaesthesia management. Best Pract Res Clin Anaesthesiol. 2017;31(1):125–38.CrossRefGoogle Scholar
  13. 13.
    Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2000;183(2):444–8.CrossRefGoogle Scholar
  14. 14.
    O’Brien JM, Shumate SA, Satchwell SL, et al. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol. 2002;186(3):475–9.CrossRefGoogle Scholar
  15. 15.
    Woudstra DM, Chandra S, Hofmeyr GJ, et al. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010;9:CD008148.Google Scholar
  16. 16.
    Ramin SM, Vidaeff AC, Yeomans ER, Gilstrap LC. Chronic renal disease in pregnancy. Obstet Gynecol. 2006;108:1531–9.CrossRefGoogle Scholar
  17. 17.
    Davison J, Baylis C. Renal disease. In: De Swiet M, editor. Medical disorders in obstetric practice. 3rd ed. Oxford: Blackwell; 1995. p. 226–305.Google Scholar
  18. 18.
    Hall M, Brunskill NJ. Renal disease in pregnancy. Obstet Gynaecol Reprod Med. 2010;20(5):131–7.CrossRefGoogle Scholar
  19. 19.
    Mathiesen ER, Ringholm L, Feldt-Rasmussen B, Clausen P, Damm P. Obstetric nephrology: pregnancy in women with diabetic nephropathy e role of antihypertensive treatment. Clin J Am Soc Nephrol. 2012;7:2081–8.CrossRefGoogle Scholar
  20. 20.
    Smyth A, Garovic VD. Systemic lupus erythematosus and pregnancy. Minerva Urol Nefrol. 2009;61:457–74.PubMedGoogle Scholar
  21. 21.
    Bramham K, Lightstone L. Pre-pregnancy counselling for women with chronic kidney disease. J Nephrol. 2012;25:450–9.CrossRefGoogle Scholar
  22. 22.
    Palevsky PM. Perioperative management of patients with chronic kidney disease or ESRD. Best Pract Res Clin Anaesthesiol. 2004;18:129–44.CrossRefGoogle Scholar
  23. 23.
    Baxi V, Jain A, Dasgupta D. Anaesthesia for renal transplantation: an update. Indian J Anaesth. 2009;53:139–47.PubMedPubMedCentralGoogle Scholar
  24. 24.
    de Souza CM, Tardelli MA, Tedesco H, Garcia NN, Caparros MP, Alvarez-Gomez JA, et al. Efficacy and safety of sugammadex in the reversal of deep neuromuscular blockade induced by rocuronium in patients with end-stage renal disease: a comparative prospective clinical trial. Eur J Anaesthesiol. 2015;32(10):681–6.CrossRefGoogle Scholar
  25. 25.
    Chao AS, Huang JY, Lien R, Kung FT, Chen PJ, Hsieh PC. Pregnancy in women who undergo long term haemodialysis. Am J Obstet Gynecol. 2002;187:152–6.CrossRefGoogle Scholar
  26. 26.
    Luciani G, Bossola M, Tazza L, Panocchia N, Liberatori M, De Carolis S, et al. Pregnancy during chronic hemodialysis: a single unit experience with five cases. Ren Fail. 2002;24:853–62.CrossRefGoogle Scholar
  27. 27.
    Lindheimer MD, Grunfeld JP, Davison JM. Renal disorders. In: Barron WM, Lindheimer MD, editors. Medical disorders during pregnancy. 3rd ed. St. Louis: Mosby; 2000. p. 39–70.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gulay Ok
    • 1
  1. 1.Manisa Celal Bayar University School of Medicine, Department of Anesthesiology and ReanimationManisaTurkey

Personalised recommendations