Saturday, 16 April 2016

Pregnancy and Kidney Disease

Pregnancy and Kidney Disease
Pregnancy is not contraindicated in most women with diabetic nephropathy or kidney disease. There is good evidence to suggest that women with very mild kidney disease (stages 1-2), normal blood pressure, and little or no protein in the urine (called "proteinuria") can have a healthy pregnancy. 

Maternal and pri-birth outcomes are generally good with a strict control of sugar and blood pressure. Although mortality is low, maternal and neonatal morbidity are higher when compared to non-diabetics and diabetic women without nephropathy. The major obstetrical complications are preeclampsia, fetal growth restriction and preterm birth.

Pre-conceptional treatment with drugs like angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in women with microalbuminuria may have benefits that extend through the pregnancy. These agents should not be used during pregnancy as they are teratogenic in nature.
Pregnancy does not appear to accelerate the progression of diabetic nephropathy in women with a mild to moderate decline in renal function.

Women with moderate to severe renal impairment (serum creatinine level >1.5 mg/dL, proteinuria >3g in 24 hours) may benefit from renal transplantation or dialysis therapy before initiating pregnancy.
In women with moderate to severe kidney disease (stages 3-5), the risk of complications is much greater. For some women, the risk to mother and child is high enough that they should consider avoiding pregnancy.
If you are thinking of becoming pregnant, ask your doctor or other healthcare provider about your stage of kidney disease, your risk for complications, your degree of proteinuria, and any other health conditions you may have.
Speaking about the same, Dr SS Agarwal – National President IMA & Padma Shri Awardee Dr KK Aggarwal – Honorary Secretary General IMA & President HCFI said, “While women with mild kidney disease are seen to have safe pregnancies, women with kidney failure are usually advised against becoming pregnant given that the rate of complications is very high. If you suffer from kidney disease and are thinking of becoming pregnant, it is important that you consult your doctor about the pros and cons. People who have had a kidney transplant are likely to have regular menstrual periods and good general health. Therefore, getting pregnant and having a child is possible. But you should not become pregnant for at least one year after your transplant, even with stable kidney function”. 

There are always options and one must not lose hope. It is important to be honest with one’s medical provider and discuss all possible options.

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