title: Managing glomerular disease in pregnancy.
abstract: Glomerular disease, especially lupus nephritis, is common in young women of childbearing age. As such, practicing nephrologists must have adequate knowledge and expertise to prepare these women for pregnancy, to diagnose and manage the numerous pregnancy-associated complications that are common in this vulnerable patient population and finally to support these young women who often struggle to manage both their young children along with an often onerous chronic disease. In this article we will review the pre-pregnancy counseling these women should ideally receive to allow them to make an informed decision about proceeding with a pregnancy, an approach to the diagnosis of pregnancy-associated worsening of kidney function and proteinuria as well as pregnancy-safe management strategies, including immunosuppression, antihypertensive agents and other medications necessary for the management of nephrotic syndrome. Gaps in our current knowledge and opportunities for collaborative research will be discussed throughout.
authors.affiliation: Division of Nephrology and Obstetrical Medicine, Department of Medicine and Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Hladunewich
authors.affiliation: Division of Transplantation Immunology and Mucosal Biology, Department of Renal Medicine, King's College, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Bramham
authors.affiliation: Division of Nephrology, Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Jim
authors.affiliation: Division of Nephrology, Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Maynard
mesh_terms: D019468:Disease Management; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007678:Kidney Glomerulus / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control*
keywords: biopsy; glomerular disease; immunosuppression; pre-eclampsia; pregnancy