30th June 2023

Renal disease

The increased cardiac output associated with pregnancy results in a rise in creatinine clearance and eGFR during pregnancy. This often leads to an improving renal function picture on bloods in mild pre-existing renal disease; however, the long-term impact of the increased workload results in worsening of the underlying condition.

Chronic kidney disease

Women with grade 4 CKD should be warned that pregnancy may impair their function further and mean they reach the threshold for dialysis. For women already on dialysis, increased frequency is required. They are often swapped to haemodialysis if on peritoneal dialysis to reduce the risk of intra-abdominal infection, practical issues relating to space available for peritoneal dialysis with a gravid uterus, and due to improved pregnancy outcomes for haemodialysis over peritoneal dialysis.

Renal transplantation

The majority of women with a renal transplant who then go through pregnancy have good outcomes. In many cases, the transplanted kidney copes well with the increased physiological requirements and they remain stable. The best outcomes are found between 1-5 years post-transplant.

Tacrolimus and ciclosporin can be used throughout pregnancy, as can steroids. Mycophenolate mofetil and cyclophosphamide should be avoided.