Pregnancy is the desire for a woman to have a baby, and it should be known that kidney problems do not stop a woman from having a baby. But it is quite difficult for a woman who has kidney problems while she is pregnant. This is true for conditions like diabetes, lupus and chronic high blood pressure. Although kidney disease during pregnancy poses complications to a patient’s present and future health. Pregnant women with chronic kidney disease are at higher risk for complications such as preeclampsia, preterm delivery, restricted fetal growth, and need for cesarean-section(C-section).
The above mentioned challenges should be managed carefully with the help of a specialized care team which includes a nephrologist in Bangalore and maternal-fetal medicine doctor. High risk pregnancy has a special approach to deal with these patients differently based on the following:
- Had kidney disease prior to pregnancy
- Have received a kidney transplant
- Were diagnosed with kidney complications during pregnancy
What to consider for pregnancy with kidney disease
There are many conditions to consider when a woman is pregnant and has kidney problems. Let us now consider all possible considerations and also understand how to deal with it.
1). Kidney Disease prior to pregnancy – If a woman has kidney disease, it is ideal to meet a nephrologist in Bangalore before she becomes pregnant to help optimize her health. Such conditions that affect an increased risk of fetal complications such as preterm birth and loss of pregnancy. Some women with moderate to severe kidney disease develop end-stage renal disease after they become pregnant.
Kidney problems during pregnancy increases the risk of worsening iron-deficiency anemia, reduced vitamin D levels and high blood pressure. Your nephrologist in Bangalore and the MFM team can help get your red blood cell, vitamin D, blood pressure and blood sugar levels to the right levels before you become pregnant so that both you and your baby are safe.
During the process of dialysis, pregnant women face additional challenges as low kidney function attributes to patients’ body stores more waste products, which could affect the growth of the baby. It is also found that dialysis contributes to fertility changes such as changes in ovulation and effects of medication that alter the menstrual cycle. Other complications of kidney disease are emotional such as not wanting to have sex or feeling less attractive than before.
There have been reports that sexual function and desire returns for most patients after dialysis or transplant.
Although dialysis during pregnancy is difficult, it is possible. According to a recent study on fertility during dialysis, 18 out of 1,000 women became pregnant during dialysis. Discuss with your nephrologist in Bangalore and your care team to determine whether pregnancy is safe for you and also increase the options of better outcomes.
2). Recieved a Kidney Transplant – When a woman gets a kidney transplant, it is usually recommended that she should not conceive for the next two years. Yet another reason to wait a little is that there could be a chance of organ rejection. Once the patient is out of the risk of organ rejection having a stable kidney function, they can safely consider pregnancy.
A pregnancy after kidney transplant usually tends to have a better outcome than the one during dialysis. You should remember that you should maintain your blood pressure and talk to your nephrologist in Bangalore about the rejection medications . Most of these drugs are found to be safe during pregnancy but some defects are that there can be some birth defects or pregnancy complications although your care team can help you with a safer alternative, ideally before you conceive.
3). Diagnosed with Kidney Complications during Pregnancy – There could be many health conditions causing kidney trouble during pregnancy.
- Infections – A urinary tract infection without any symptoms known as Asymptomatic bacteriuria could prevail during pregnancy. If left untreated, it can evolve into a kidney infection(pyelonephritis). Kidney infections usually would require hospitalization and IV antibiotic procedure. Since complications are more severe in pregnant women, take an appointment with a nephrologist in Bangalore, as in some cases it can include respiratory issues for the mother and preterm baby.
- Kidney Stones – Study has shown that pregnancy does not increase the risk of kidney stones, although the dilation of the ureter which comes during pregnancy might make it easier to pass stones during pregnancy. Treatment for kidney stones usually consists of hydration and over-the-counter pain medicine.
- Preeclampsia – High blood pressure during pregnancy is usually associated with reduced kidney function which can in turn lead to preterm birth. High amounts of protein in the urine can be a warning sign of preeclampsia, which is often checked.
Patients who hemorrhage or have placental abruption might develop acute kidney injury(AKI), or sudden kidney failure. Nephrologists in Bangalore are able to manage this situation as AKI is not so common.
Signs of Kidney Problems in Pregnancy – Pyelonephritis is a common kidney disease that occurs during pregnancy, and the symptoms are as follows –
- Frequent urination
- Urgency in urination
- Painful urination or dysuria
- Blood in urine or hematuria.
How common are kidney problems during pregnancy
- Some women do have chronic kidney disease for the first time during pregnancy.
- Around 20% of women develop early preeclampsia, that is less than 30 weeks of gestation.
- Those women with heavy proteinuria
- Those who have unrecognised chronic kidney disease.
How does pregnancy affect kidney function – During pregnancy the volume of kidneys increases by 30%, and this increase is attributed to increased vascular and intestinal volume rather than any changes in the number of nephrons.
How are kidney infections treated during pregnancy – If a pregnant woman develops a kidney infection during pregnancy, they would need to get admitted to the hospital to get a proper treatment. The treatment involves a short course of antibiotics and intravenous fluids, which may not cause any harm to the developing fetus.
Why does urinary tract infection occur during pregnancy – The urine of a pregnant woman has more sugar, protein and hormones, and these are the reasons for a UTI. Another reason for UTI in pregnant women is that the growing uterus presses on the bladder, making it hard to let out the urine from the bladder.
Can kidney disease cause miscarriage – Some conditions that affect the kidneys are associated with an increased risk of fetal complicationssuch as preterm birth and pregnancy loss. Some pregnant women with moderate to severe kidney disease develop end-stage-renal disease after pregnancy.
If you are planning a pregnancy, ensure that you talk to your healthcare provider as they know about your general health. There are some things that affect a healthy pregnancy:
- Your stage of kidney disease
- Your general health
- Your age
- Having high blood pressure, diabetes, or heart disease
- Having other serious health conditions
- Protein in urine
In general, women with chronic kidney disease are less able to make renal adaptations needed for a healthy pregnancy. Their inability to boost renal hormones often leads to anaemia, reduced expansion of plasma volume, and vitamin D deficiency. If preeclampsia develops, maternal renal function often deteriorates further, reducing renal blood flow resulting in peripartum haemorrhage. A regular usage of non-steroidal anti-inflammatory drugs, can seriously threaten maternal renal function. In such circumstances, consult a nephrologist in Bangalore who would suggest that nephrotoxic drugs should be avoided and maternal circulation restored with careful fluid management, as women with preeclampsia are usually prone to pulmonary oedema.