Kidney Diseases in Pregnancy

Pregnancy places extra demands on the kidneys, and women with existing kidney disease, or those who develop a kidney problem during pregnancy, need careful joint care. With planning and close monitoring by a nephrologist and obstetrician working together, many women with kidney conditions can have a safer pregnancy.

How Pregnancy Affects the Kidneys

During a normal pregnancy, blood flow to the kidneys and the filtration rate rise considerably. The kidneys and urinary tract also enlarge slightly, and hormonal changes can slow the flow of urine. These changes are normal, but they mean that blood test values in pregnancy are interpreted differently.

In women whose kidneys are already affected, this extra workload may lead to a rise in protein in the urine, higher blood pressure or a decline in kidney function.

Kidney Conditions Seen in Pregnancy

Kidney problems in pregnancy fall broadly into two groups: pre-existing kidney disease and kidney problems that start during pregnancy.

• Chronic kidney disease from any cause, including diabetes and glomerulonephritis
• Lupus nephritis and other autoimmune kidney diseases
• Polycystic kidney disease and other inherited conditions
• Urinary tract infections and kidney infection (pyelonephritis)
• Pre-eclampsia, which may affect the kidneys
• Acute kidney injury from severe vomiting, bleeding, infection or pregnancy complications
• Pregnancy in women with a kidney transplant or on dialysis

Symptoms to Watch For

Some swelling of the feet is common in pregnancy, which is why kidney problems can be missed. Contact your doctor promptly if you notice any of the following.

• Sudden swelling of the face, hands or legs
• Frothy urine or reduced urine output
• Burning or pain while passing urine, fever or back pain
• Headache, blurred vision or pain in the upper abdomen
• High blood pressure readings at home or in clinic

Diagnosis and Monitoring

Assessment usually includes regular blood pressure checks, urine tests for protein and infection, blood tests for kidney function and electrolytes, and ultrasound of the kidneys when needed. Women with known kidney disease are ideally reviewed before conception so that the likely risks can be discussed and medicines reviewed.

Treatment and Care Planning

Care is individualised and shared between the nephrologist, obstetrician and, where needed, other specialists.

Lifestyle measures also matter. Staying well hydrated, not delaying passing urine, attending every antenatal visit and keeping a record of home blood pressure readings can all help your care team spot changes early. After delivery, some medicines may need to be changed again, particularly if you are breastfeeding, so a follow-up visit with your nephrologist in the weeks after childbirth is usually recommended.

• Pre-pregnancy counselling on timing, risks and disease control
• Switching medicines that are unsafe in pregnancy to safer alternatives before conception
• Keeping blood pressure within a target range agreed by your doctors
• Prompt treatment of urinary infections
• Close monitoring of kidney function and protein levels through each trimester
• Planning for delivery and follow-up after childbirth
• Specialised care for pregnancy on dialysis or after kidney transplant

When to See a Nephrologist

Consult a nephrologist if you have kidney disease and are planning a pregnancy, if protein or blood is found in your urine during pregnancy, if your creatinine is raised, or if you have had pre-eclampsia or kidney problems in a previous pregnancy. A review after delivery is also advisable if kidney changes were noticed during pregnancy.

This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.