Renal diseases during pregnancy can include a variety of conditions that affect the kidneys, such as preeclampsia, gestational hypertension, and pyelonephritis (a kidney infection). These conditions can lead to serious complications for both the mother and the baby if left untreated. Preeclampsia, for example, is a condition characterized by high blood pressure and protein in the urine, and can potentially lead to eclampsia (seizures) and organ damage. It is important for pregnant women to be aware of the symptoms of these conditions and to seek prompt medical attention if they suspect they may be experiencing any of them.

1. Renal Diseases in pregnancy

2. Pr-epregnancy counselling
Safe contraception until pregnancy advised
Genetic counselling if inherited disorder
Risks to mother and fetus during pregnancy
Avoid known teratogens and contraindicated drugs
Treatment of blood pressure and adjustment of antihypertensives
Low-dose aspirin
Need for anticoagulation once pregnant in women with significant proteinuria
possibility of accelerated decline in maternal renal function (in advanced stages )
need for postpartum follow-up

4. Effect of pregnancy on CKD
If mild, no or minimal effect (Cr less than 1.25)
If moderate and sever , it worsen (stage 3-5 ) Cr more than 1.8
women with the most impaired renal function have the worst pregnancy outcome
Chronic renal failure with Cr more than 2.5 is contraindicated

5. Effect of CKD on pregnancy outcome
Depends on the stage of the disease
Includes :
preterm delivery
delivery by caesarean section
fetal growth restriction (FGR)
Preeclampsia
VTE

6. Monitoring needed in CKD during
pregnancy
CBC & FERRITIN
KFT
RENAL ULTRASOUND
URINE ANALYSIS
FETAL ULTRASOUND (detailed anomalies scan and fetal growth)
UTERINE ARTERY DOPPLER 20-24 WEEKS GA

7. Complications in patients on dialysis
Usually they have more complications as they are on stage 5 CKD
Advice against pregnancy in patients on dialysis
preterm delivery
polyhydramnios (30–60%)
 pre-eclampsia (40–80%)
 caesarean delivery (50%)

8. Pregnancy in women with renal
transplants (important )
oMore than 90 percent goes uncomplicated
oPregnancy is allowed 2 years after stable graft (no recent rejection ,
controlled blood pressure , acceptable serum creatinine )
oIn pregnancy review drugs safety , KFT , blood pressure , fetal
growth
oIf renal function declines, exclude: obstruction; infection; rejection

9. complications include preterm delivery, pre-eclampsia and urinary tract infection
The risk of acute rejection in pregnancy is estimated at 2%
Vaginal delivery is considered safe
Tacrolimus, azathioprine, ciclosporin and prednisolone are generally considered safe in
pregnancy and for the breastfed infant and should be continued
Screening for gestational diabetes (GDM) is necessary with prednisolone and tacrolimus

10. Acute kidney injury causes and presentation :
Most common cause : preeclampsia , eclampsia (6%), HELLP syndrome (50 %)
Other important and common causes : sever hemorrhage , use of NSAID especially postpartum
Others : infections and obstruction
Presentation : most common period is the early post partum period with hyperkalemia , metabolic
acidosis , oliguria , elevated creatinine and urea in serum

11. Urinary tract infections
Asymptomatic bacteriuria : 4-8 % and 40 % will develop
symptomatic infection if untreated
Acute cystitis 1 %
Acute pyelonephritis 1-2 %
Risks factors : more in women with DM, Sickle cell trait and
disease, immunosuppressed , urinary tract stones, polycystic
kidney, renal congenital anomalies

12. Symptoms of pyelonephritis includes: nausea , vomiting , loin pain , fever
Symptoms of cystitis includes suprapubic pain and dysuria
Positive dipsticks should always be followed by MSU culture
All bacteriuria should be treated to prevent pyelonephritis and preterm labor
with 3-7 days of broad spectrum antibiotic
Acute cystitis should be treated with 7 days antibiotic
Pyelonephritis is treated with 10-14 days of antibiotics