BMJ  2008;336:211-215 (26 January), doi:10.1136/bmj.39406.652986.BE

Practice

Pregnancy Plus

Chronic kidney disease in pregnancy

¹ Institute for Women’s Health, EGA Obstetric Hospital, University College London Hospitals, London WC1E 6DH, ² Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne

Pregnant women with chronic renal disease adapt poorly to a gestational increase in renal blood flow. This may accelerate their decline in renal function and lead to a poor pregnancy outcome

Chronic kidney disease is often clinically and biochemically silent until renal impairment is advanced. Symptoms are unusual until the glomerular filtration rate declines to <25% of normal, and more than 50% of renal function can be lost before serum creatinine rises above 120 µmol/l. Women who become pregnant with serum creatinine values above 124 µmol/l have an increased risk of accelerated decline in renal function and poor outcome of pregnancy (see Scenario box).^{1234 w1} Several factors must be considered when managing pregnant women with chronic kidney disease to minimise the adverse effects of pregnancy on maternal renal function and the consequent effects on the fetus.

Chronic kidney disease is now widely classified into five stages according to the level of renal function (table 1).^w2 Stages 1 and 2 (normal or mild renal . . . [Full text of this article]

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