title: Pregnancy in chronic kidney disease and kidney transplantation.
abstract: Chronic kidney disease (CKD) affects up to 6% of women of childbearing age in high income countries, and is estimated to affect 3% of pregnant women. Advanced renal dysfunction, proteinuria, hypertension, and poorly controlled underlying primary renal disease are all significant risks for adverse maternal, fetal, and renal outcomes. In order to achieve the best outcomes, it is therefore of paramount importance that these pregnancies are planned, where possible, to allow the opportunity to counsel women and their partners in advance and to optimize these risks. These pregnancies should be deemed high risk and they require close antenatal monitoring from an expert multidisciplinary team. We discuss the effect of pregnancy on CKD, and also current guidelines and literature with specific reference to transplantation, autoimmune disease, and medication use in pregnancy. We also discuss the benefits of prepregnancy counseling and give practical recommendations to advise pregnant women with renal disease.
authors.affiliation: Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Webster
authors.affiliation: Section of Renal Medicine and Vascular Inflammation, Department of Medicine, Imperial College London, United Kingdom.
authors.forename: Liz
authors.initials: L
authors.lastname: Lightstone
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Diego, California, USA.
authors.forename: Dianne B
authors.initials: DB
authors.lastname: McKay
authors.affiliation: Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA. Electronic address: mjosephs@medicine.bsd.uchicago.edu.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Josephson
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D037001:Directive Counseling; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003404:Creatinine
keywords: acute rejection; chronic kidney disease; kidney transplantation; outcomes; pregnancy