Chapter 27
Pregnancy
Georgina Irish,
Shilpanjali Jesudason,
Georgina Irish
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorShilpanjali Jesudason
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorGeorgina Irish,
Shilpanjali Jesudason,
Georgina Irish
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorShilpanjali Jesudason
Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Major physiological adaptive changes to renal hemodynamics, and glomerular and tubular function occurs with pregnancy. This chapter discusses pregnancy in women with chronic kidney failure at all stages. Clinical decision-making in this high-risk cohort is focused mainly on risk assessment for maternal and fetal outcomes, with very limited evidence regarding interventions. The number of pregnancies in patients receiving dialysis reported in the literature is increasing over time, although they remain rare. The safety of kidney biopsy in pregnancy is contentious. The impact of primary renal disease varies depending on the specific disease and the severity of kidney dysfunction. Women planning pregnancy should cease smoking, commence folic acid and vitamins, exchange teratogenic medications for pregnancy-safe options, and address relevant comorbidities including infection, anemia, and diabetes. Controlling hypertension before and during pregnancy is essential.
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