Renal disorders in pregnancy can include urinary tract infections, chronic kidney disease, and acute renal failure. Urinary tract infections are common and usually caused by E. coli, with symptoms of urinary frequency and pain. Chronic kidney disease risks worsening renal function and adverse fetal outcomes depending on severity. Acute renal failure is rare but can result from infection, blood loss, preeclampsia, or obstruction. Management depends on the underlying cause but may include antibiotics, blood volume replacement, or controlling blood pressure. Pregnancy in renal transplant recipients has risks but can succeed with careful monitoring and maintenance of immunosuppressive drugs.

1. Renal Disorders in Pregnancy
Mukesh Sah
Post Graduate Medical Intern

2. RENAL DISORDERS
Urinary tract infection
Chronic renal disease
Acute renal failure
Pregnancy in renal transplant recipient

3. Urinary Tract Infection
Asymptomatic bacteriuria: 75-90% due to E coli. Colonization of
urinary tract results from ascending infection from the perineum
and is related to sexual intercourse. Antibiotics such as ampicillin,
amoxicillin is given for the treatment.
Acute cystitis: Cystitis is an inflammation of the bladder. In most
cases, the cause of cystitis is a urinary tract infection (UTI)
• Clinical features: urinary frequency, dysuria, hematuria and
suprapubic pain

4. • Advice should be given for Increase fluid intake, emptying the
bladder following sexual intercourse. Antibiotics is given for the
treatment.
Acute pyelonephritis:
Acute pyelonephritis is a sudden and severe kidney infection. It
causes the kidneys to swell and may permanently damage them.
Pyelonephritis can be life-threatening.

5. Clinical features:
• Fever
• Abdominal pain
• Vomiting
• Proteinuria
• Hematuria
Management: Iv antibiotic penicillin and cephalosporin are the 1st
choice.

6. CHRONIC RENAL DISEASES IN
PREGNANCY
• The incidence of chronic renal disease in pregnancy is rare.
• Renal disease in pregnancy is an important medical disorder
resulting in worsening of renal function, and increased fetal
morbidity and mortality
Mildly compromised renal function:
Serum creatinine <125 μmol/L is generally not associated with any
adverse maternal or fetal outcome. Effect of pregnancy on long-term
renal function and development of end stage renal failure (serum
creatinine >500 μmol/L or the need of dialysis is very low (5%)

7. Moderate or severely compromised renal function (high serum
creatinine>125μmol/L) is generally associated with adverse
pregnancy outcome (50%) as the renal function deteriorates.
Pregnancy outcome is adversely affected by the rising level of
proteinuria, hypertension and serum creatinine.

8. EFFECTS OF RENAL DISEASE ON
PREGNANCY
• Pregnancy outcome depends on the level of hypertension
proteinuria and serum creatinine.
• Abortion, preterm labor, IUGR and IUFD are the known fetal risks.
However, with improved pregnancy surveillance and neonatal care,
outcome has improved.

9. EFFECTS OF PREGNANCY ON RENAL
DISEASE
• It depends on the severity of renal disease. When the renal function
is mildly compromised (serum creatinine<125m mol/L) the risk of
end stage renal failure is low (5%).

10. MANAGEMENT
Pre-pregnancy counselling
Women with severely compromised renal function should be
discouraged to become pregnant as the risks of developing end stage
renal failure is high.
Antenatal care and delivery:
Its aim is to assess the renal function (proteinuria, creatinine
clearance, urinary tract infection). Antihypertensive therapy is started
early to preserve renal function

11. ACUTE RENAL FAILURE
• Rare complication in pregnancy in which sudden decrease in renal
function with oliguria over a period of hours or days.
Clinical features: Anuria/oliguria, creatinine rises, decreased GFR
Causes:
• Infection: septic abortion, puerperal sepsis, rarely acute
pyelonephritis

12. • Blood loss: postpartum hemorrhage, abruption.
• Volume contraction: pre-eclampsia, eclampsia.
• Post-renal failure: ureteric damage or obstruction
• Pre-eclampsia
• HELLP syndrome:

13. Management: this depend on underlying cause.
• Blood volume replacement for hemorrhage, control blood pressure.
• Infection should be controlled by antibiotics in septic abortion and
puerperal sepsis.

14. PREGNANCY IN RENAL TRANSPLANT
RECIPIENTS
• Women receiving renal transplants should be warned that as renal
function returns to normal, ovulation, menstruation and fertility
also resume.
• Women desiring pregnancy are usually advised to wait about 1-2
years after transplantation

15. Effects of pregnancy on renal transplants
• Pregnancy probably has no adverse long-term effect
• Renal allograft adapt to pregnancy.
• About 15% of women develop significant impairment.
• About 40% develop proteinuria towards term.

16. Effect of renal transplants on pregnancy
• The chance of successful outcome is >90%, but this is reduced to
70% if complications occur before 28 weeks gestation.
• The complication rate is higher for diabetics.

17. Management
Immunosuppressive drugs are maintained at prepregnancy
• Levels which should preferably be:
Prednisolone, <15 mg/day plus either
Azathioprine, <2mg/kg/day
Cyclosporin A, 2-4mg/kg/day
Caesarean section is only required for obstetric indications
Prophylactic antibiotics should be given to cover any surgical
procedure including episiotomy.

18. Assignment
• How pre-eclampsia and eclampsia causes the renal failure in
pregnancy?

19. References
■ Dutta’s DC. Textbooks of obstetrics including perinatology and contraceptive.
7thed. Jaypee brothers medical publishers (p) ltd; 2013.239-240 p.
• https://www.slideshare.net/BILLAISBACK/renal-diseases-in-pregnancy-
dr-praythiesh-bruce-mbbs
• https://www.slideshare.net/ahsanshafiq90/renal-disorders-in-
pregnancy
• https://slideplayer.com/slide/6426391/