15th July 2024

Chronic kidney disease

Currently, chronic kidney disease (CKD) affects 3% of pregnancies, and it is likely its incidence will increase. All stages of CKD lead to an increased risk of adverse outcomes, including miscarriage, intrauterine growth restriction and preterm labour. CKD is also a risk factor for pre-eclampsia, the risk and severity of which increases with worsening CKD. For women with progressive CKD, pregnancy accelerates the deterioration of their renal function. Therefore, antenatal counselling and close monitoring during pregnancy is critical. Prior to conception, poorer baseline renal function is associated with lower fertility rates due to lower oestrogen/progesterone, decreased FSH and LH, earlier menopause and often reduced sexual interest.

Women with pre-existing nephrotic range proteinuria (uPCR>300 mg/mmol or uACR>250 mg/mmol) should take low molecular weight heparin when pregnant. This is usually continued until 6 weeks postpartum.

Target blood pressure for women with CKD in pregnancy is below 135/85 mmHg.