Preeclampsia with Pre-existing Kidney Disease

[expert on call]

I have read some forums and did not see any addressing kidney disease prior to pregnancy.
I am 37 and seriously considering getting pregnant for the first time.
It has always been a huge fear for me as I do not want to increase my chance of being on dialysis.

I was born with reflux which was not corrected for 3 years.
Actually at that time the surgeon only reimplanted one side.
The other side was not repaired until the age of 8.
Needless to say I spent many years with high fevers and kidney infections.

This has left me with poor kidney function.
The left kidney at 14% and the right kidney at 86%.
On renogram my GFR is 64ml/minute.

My Nephrologist has monitored me for the past 10 years and never says "Don't get pregnant".
But in the back on my head, I can still hear as a child the urologist tell my mom it would be dangerous.

My blood pressure runs 130-140/90-110.
I am on blood pressure medicine and prophylactic antibiotics.
My fear is dialysis something I don't think I could deal with.

But after reading on your website, now I am concerned with Eclampsia.
Does anyone have any experience with chronic kidney disease and Eclampsia?

Thanks for your time!!
I am,
Linda


Expert on Call

[expert on call]

Renal disease does represent a considerable risk for the development of preeclampsia and other hypertensive problems in pregnancy. The risk of adverse maternal outcome, including eclampsia, can be largely managed with careful prenatal care.

Management of maternal complications can require preterm delivery. The major risk to the pregnancy is a significantly premature baby. While outcomes after 32 weeks are generally very good, more and more long term problems are encountered by babies born at earlier and earlier gestations.

The risk of progression of renal disease in association with pregnancy has been studied. For women with a serum creatinine ¾ 1.5, the risk of deterioration due to the pregnancy is small. For creatinine > 2.5, the risk is substantial. (Once creatinine is > 2.5 a large number of patients will progress to dialysis). Your GFR suggest a creatinine in the range of 1.3 to 1.4.

Actively inflammatory renal lesions seem to due worse than long term stable lesions.

Blood pressure control, (with dBP < 80-85), is an important intervention to reduce the progression of kidney disease towards dialysis. Generally, diastolic BP's less than 80 are recommended.

Information provided on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disorder, or prescribing any medication. The Preeclampsia Foundation presents all data as is, without any warranty of any kind, express or implied, and is not liable for its accuracy, for mistakes or omissions of any kind, nor for any loss or damage caused by a user's reliance on information obtained on the site. Professional opinions on this condition vary greatly. The Preeclampsia Foundation endorses no one course of treatment or "cure". Responses generated by our Experts to specific questions are based on information anonymously submitted to this site via email, are not based on a complete review of any patient’s medical records and should not be construed as the only reasonable expert response to the info submitted and/or the scenario described.

[expert on call]

There is a literature regarding pregnancy in women with reflux nephropathy that her nephrologist may be aware (reviewed for example the normal and diseased kidney in pregnancy chapter in the 2001 (7th) edition of RW Schrier’s text, Diseases of the Kidney, NY Lippincott, Williams, & Wilkens. Also she should not be afraid to specifically ask her nephrologist for advice.. For instance there are very large series from France (Junger’s group in Paris) and Australia (Kincaid-Smith’s group in Melbourne). It appears that in the absence of hypertension and with preserved renal function pregnancy or only mild functional loss that over 95% of the gestations succeed and there is little or no evidence of that pregnancy has a deleterious course on the natural history of the renal disease. With hypertension and moderate dysfunction there is a risk of renal deterioration and a marked increase in superimposed preeclampsia as well as loss of control of the preexisting hypertension, values rising to levels considered severe.

Since this patient already has hypertension (that carries a 20-25% incidence of superimposed preeclampsia) and has what sounds like moderate renal functional loss her risks are substantial. If her blood pressure has not been treated adequately in the past and can now be controlled more effectively and her serum creatinine levels are below 1.5 mg/dl (possible if her glomerular filtration by creatinine clearance is really 64 ml/min,(renography not being that adequate to measure clearances) some would consider monitoring a pregnancy in such a patient at a tertiary center under the care of a nephrologists and fetal-maternal-medicine subspecialist, (these physicians, obviously being a bit more optimistic than the advice above).

Again the patient should reconsult her nephrologists with specific questions. The nephrologists should be familiar with the literature mentioned above (or can seek one of us for further advice).

Information provided on this site is provided for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disorder, or prescribing any medication. The Preeclampsia Foundation presents all data as is, without any warranty of any kind, express or implied, and is not liable for its accuracy, for mistakes or omissions of any kind, nor for any loss or damage caused by a user's reliance on information obtained on the site. Professional opinions on this condition vary greatly. The Preeclampsia Foundation endorses no one course of treatment or "cure". Responses generated by our Experts to specific questions are based on information anonymously submitted to this site via email, are not based on a complete review of any patient’s medical records and should not be construed as the only reasonable expert response to the info submitted and/or the scenario described.