To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Women with kidney disease have an increased risk of adverse maternal and fetal outcomes and it is now recognised that kidney disease is much more common than previously appreciated. By using an estimation of glomerular filtration rate (eGFR) rather than serum creatinine to assess renal function, between 3% and 10% of women of childbearing age might be defined as having chronic kidney disease (CKD). Physicians in both primary and secondary care need to be alert to advising women with renal disease that they might be at risk, but they need guidelines as to who to alert and how to advise on the degree of risk. This chapter will address these issues in more detail. The aim is to advise all women who are at increased risk of that risk prior to conception — not only so that appropriate investigations and medication changes can be implemented safely well in advance but to avoid the emotional trauma of only discovering, once pregnant, that pregnancy might be associated with long-term complications. Importantly, many women with kidney disease may be entirely unaware that their condition could affect a pregnancy.
Who should have prepregnancy counselling?
The role of prepregnancy advice is to make a woman and her partner aware of the risks a pregnancy may pose to her health and that of the fetus, to give guidance as to the best time to contemplate pregnancy (i.e. sooner, if she has progressive renal disease, or later, if she has a relapsing condition that has recently flared), and to provide the opportunity to optimise treatment to ensure she is not on teratogenic medications at the time of conception and to focus her on the need for optimal control of risk factors such as hypertension and hyperglycaemia.
Some renal problems are more likely to be diagnosed in pregnancy than others. Urinary abnormalities will almost always be detected as a result of the near universal application of urinary dipstick testing throughout pregnancy. Renal dysfunction without associated urine abnormalities may be less likely to be diagnosed as the biochemical profile is not part of routine booking blood work. However, serum creatinine is usually measured in women who present with urine abnormalities, hypertension/pre-eclampsia and/or recurrent urine infections as well as unexplained severe anaemia. Thus pregnancy provides an opportunity to identify women with hitherto undiagnosed or new-onset kidney problems. How these women should be followed up postpartum depends on the presentation and the severity.
There are some basic principles that should be followed. All women found to have a renal problem need to have a renal diagnosis made, ideally during pregnancy but certainly postpartum where that is not practical. For instance, during pregnancy this may be a simple matter of the woman having a renal ultrasound that demonstrates scarred kidneys from recurrent urinary tract infections (UTIs) and hypertension, confirming the diagnosis of reflux nephropathy. In other circumstances diagnosis might not be confirmed during pregnancy because of the requirement for tests that pose an unacceptable risk to the mother or baby, for example certain forms of imaging. A woman who presents with modest proteinuria in early pregnancy with no hypertension, with normal function and with no markers of systemic disease would not warrant a renal biopsy during pregnancy as diagnosis will not alter management. However, if the proteinuria persists postpartum, then she may well merit biopsy to determine diagnosis and prognosis, not least for future pregnancies.
Email your librarian or administrator to recommend adding this to your organisation's collection.