Practice Pregnancy Plus

Chronic kidney disease in pregnancy

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39406.652986.BE (Published 24 January 2008) Cite this as: BMJ 2008;336:211
  1. David Williams, consultant obstetric physician 1,
  2. John Davison, emeritus professor obstetric medicine 2
  1. 1Institute for Women’s Health, EGA Obstetric Hospital, University College London Hospitals, London WC1E 6DH
  2. 2Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne
  1. Correspondence to: D Williams d.williams{at}uclh.nhs.uk

    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.

    Methods

    Evidence for this review came from Medline and Cochrane database searches, as well as the authors’ reference archives.

    How common is chronic kidney disease in pregnancy?

    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 impairment with persistent albuminuria) affect up to 3% of women of child bearing age (20-39 years).w3 Stages 3-5 (glomerular filtration rate <60 ml/min) affect around one in 150 women of childbearing age,w3 but because of reduced fertility and an increased rate of early miscarriage, pregnancy in these women is less common. Studies of chronic kidney disease in pregnancy have mostly classified women on the basis of serum creatinine values, but we estimate that around one in 750 pregnancies is complicated by stages 3-5.w4 Some women are found to have chronic kidney disease for the first time during pregnancy. Around 20% of women who develop early pre-eclampsia (≤30 weeks’ gestation), …

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