Skip to main content
SpringerLink
Log in
SpringerLink
Log in

Pregnancy and Chronic Kidney Disease

  • Chapter
  • First Online:
Management of Chronic Kidney Disease

  • 2628 Accesses

Abstract

Pregnant CKD patients present two basic and often conflicting issues: foetal prognosis (the effect of CKD on the pregnancy) and maternal prognosis (the effect of the pregnancy on the CKD, during and after the pregnancy). If prepregnancy kidney function is normal or only mildly impaired and hypertension is minimal and/or well controlled, then obstetric outcome is usually successful. There is an increased risk of antenatal complications such as preeclampsia, foetal growth restriction (FGR) and/or preterm delivery. Preeclampsia can be difficult to diagnose in CKD patients who already have hypertension and proteinuria. Greater degrees of kidney dysfunction and/or the presence of poorly controlled hypertension are more ominous, at least for maternal outcome, especially long-term kidney prognosis. The use of eGFR formulae and Cystatin C as a GFR marker is not recommended in pregnancy. Care must be undertaken by a multidisciplinary team (MDT), and this includes prepregnancy assessment and postnatal review, not just antenatal supervision.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Centre for Maternal and Child Enquiries (CMACE). Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG. 2011;118 Suppl 1:1–203.

    Google Scholar 

  2. Davison JM, Nelson-Piercy C, Kehoe S, Baker P, editors. Royal College of Obstetricians and Gynaecologists. 54th Study Group. Renal disease in pregnancy. London: RCOG Press; 2008. 273 p.

    Google Scholar 

  3. Fischer MJ. Chronic kidney disease and pregnancy: maternal and fetal outcomes. Adv Chronic Kidney Dis. 2007;14(2):132–45.

    Article  PubMed  Google Scholar 

  4. Imbasciati E, Gregorinin G, Cabiddu G, Gammaro I. Pegnancy in CKD stages 3 to 5: fetal and maternal outcomes. Am J Kindey Dis. 2007;49:753–62.

    Article  Google Scholar 

  5. Piccoli GB, Attini R, Vasario E, Conijn A, Biolcati M, D’Amico F, et al. Pregnancy and chronic kidney disease: a challenge in all CKD stages. Clin J Am Soc Nephrol. 2010;5(5):844–55.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Alsuwaida A, Mousa D, Al-Harbi A, Alghonaim M, Ghareeb S, Alrukhaimi MN. Impacts of early chronic kidney disease on maternal and fetal outcome of pregnancy. J Matern Fetal Neonatal Med. 2011;24:1432–6.

    Article  CAS  PubMed  Google Scholar 

  7. Davison JM, Lindheimer MD. Pregnancy and chronic kidney disease. Semin Nephrol. 2011;31:86–99.

    Article  CAS  PubMed  Google Scholar 

  8. Nevis IF, Reitsma A, Dominic A, McDonald S, Thabane L, Aki EA, et al. Pregnancy outcomes in women with chronic kidney disease: a systematic review. Clin J Am Soc Nephrol. 2011;6(11):2587–98.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Piccoli GB, Conijn A, Attini R, Biocalti M, Bossotti C, Consiglio V, et al. Pregnancy in chronic kidney disease: need for a common language. J Nephrol. 2011;24(3):282–99.

    Article  PubMed  Google Scholar 

  10. Picolli GB, Fassio F, Attini R, Parisi S, Biolcati M, Ferraresi M, et al. Pregnancy in CKD: whom should we follow and why? Nephrol Dial Transplant. 2012;27 suppl 3:iii111–8.

    Google Scholar 

  11. Coté AM, Sauvé N. The management challenges of non-preeclampsia-related nephrotic syndrome in pregnancy. Obstet Med. 2011;4:133–9.

    Article  Google Scholar 

  12. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from ISSHP. Pregnancy Hypertens. 2014;4:97–104.

    Google Scholar 

  13. Masujama H, Nobumoto E, Okimoto N, Inone S, Segawa T, Hiramatsu Y. Superimposed preeclampsia in women with chronic kidney disease. Gynecol Obstet Invest. 2012;74:274–81.

    Article  Google Scholar 

  14. Hennessy A, Makkris A. Preeclamptic nephropathy. Nephrology. 2011;16:134–43.

    Article  PubMed  Google Scholar 

  15. Bramham K, Lightstone L. Pre-pregnancy counseling for women with chronic kidney disease. J Nephrol. 2012;25:450–9.

    Article  PubMed  Google Scholar 

  16. Cauldwell M, Nelson-Piercy C. Maternal and fetal complications of systemic lupus erythematosis. Obstet Gynaecol. 2012;14:167–74.

    Article  Google Scholar 

  17. Royal College of Obstetricians and Gynaecologists Green Top Clinical Guideline 10(A). Management of severe preeclampsia and eclampsia. 2006, reviewed 2010.

    Google Scholar 

  18. American College of Rheumatology Guideline. American College of Rheumatology Guidelines for screening, treatment and management of lupus nephritis. Arthritis Care Res. 2012;64:797–808.

    Article  Google Scholar 

  19. Marciotti GM, Sarno L, Napolitano R, Mazzarelli LL, Quaglia F, Capone A, et al. Preeclampsia in women with chronic kidney disease. J Matern Fetal Neonatal Med. 2012;25:1367–9.

    Article  Google Scholar 

  20. National Institute for Health and Clinical Excellence (NICE) Clinical Guideline: 73. Early identification and management of CKD.

    Google Scholar 

  21. National Institute for Health and Clinical Excellence (NICE). Hypertension in pregnancy. The management of hypertensive disorders in pregnancy, Clinical Guideline: 107. London: National Institute for Health and Clinical Excellence (NICE); 2010.

    Google Scholar 

  22. Royal College of Obstetricians and Gynaecologists Green Top Clinical Guideline 37a. Reducing the risk of thrombosis and embolism during pregnancy and the puerperium 2009.

    Google Scholar 

  23. National Institute for Health and Clinical Excellence (NICE) Clinical Guideline: 169. Acute kidney injury. Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy 2013.

    Google Scholar 

  24. National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 34. Hypertension: management of hypertension in adults in primary care 2006.

    Google Scholar 

  25. Magee LA, Pels A, Helewa A, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014;4:105–45.

    Google Scholar 

  26. American College of Obstetrics and Gynecology (ACOG) guideline. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force in Pregnancy. Obstet Gynecol 2013;122:1122–31.

    Google Scholar 

  27. Picolli GB, Daidola G, Attini R, Parisi S, Fassio F, Naretto C, et al. Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review. BJOG. 2013;120:412–27.

    Article  Google Scholar 

  28. Royal College of Anaesthetists (RCA). Providing equity of critical and maternity care for critically ill pregnant or recently pregnant women. 2011.

    Google Scholar 

  29. Royal College of Obstetricians and Gynaecologists Green Top Clinical Guideline 56. Maternal collapse in pregnancy and the puerperium. 2011.

    Google Scholar 

  30. Munkhaugen J, Vikse BE. New aspects of preeclampsia: lessons for nephrologists. Nephrol Dial Transplant. 2009;24:2964–7.

    Article  PubMed  Google Scholar 

  31. Ananth CV, Cleary KM. Preeclampsia and cardiovascular disease: more questions than answers? BJOG. 2013;120:920–3.

    Article  CAS  PubMed  Google Scholar 

  32. Männistö T, Mendola P, Vääräsmäki M, Järvelin M-R, Hartikainen A-L, Pouta A, Suvanto E. Elevated blood pressure in pregnancy and subsequent chronic disease risk. Circulation. 2013;127:681–90.

    Article  PubMed  Google Scholar 

  33. Hyde C, Thornton S. Does screening for preeclampsia make sense? BJOG. 2013;120:1168–70.

    Article  CAS  PubMed  Google Scholar 

  34. Chappell LC, Duckworth S, Seed PT, Griffin M, Myers J, MacKillop L, et al. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation. 2013;128:2121–31.

    Article  CAS  PubMed  Google Scholar 

  35. Xia Y, Kellens RE. Angiotensin receptor agonistic autoantibodies and hypertension: preeclampsia and beyond. Circ Res. 2013;113:78–87.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK

    Sarah Winfield BSc, MBBS, MRCOG

  2. Institute of Cellular Medicine, Royal Victoria Infirmary and Newcastle University, 3rd Floor Leech Building, Medical School, Framlington Place, Newcastle upon Tyne, Tyne & Wear, NE2 4HH, UK

    John M. Davison MSc, MD, FRCPE, FRCOG

Authors
  1. Sarah Winfield BSc, MBBS, MRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John M. Davison MSc, MD, FRCPE, FRCOG
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John M. Davison MSc, MD, FRCPE, FRCOG .

Editor information

Editors and Affiliations

  1. Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Mustafa Arici

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Winfield, S., Davison, J.M. (2014). Pregnancy and Chronic Kidney Disease. In: Arici, M. (eds) Management of Chronic Kidney Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54637-2_28

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54637-2_28

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-54636-5

  • Online ISBN: 978-3-642-54637-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation