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Am J Kidney Dis. 2019 Jan;73(1):119-130. doi: 10.1053/j.ajkd.2018.06.006. Epub 2018 Aug 16.

Renal Disorders in Pregnancy: Core Curriculum 2019.

Author information

1
Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
2
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN.
3
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
4
Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN. Electronic address: garovic.vesna@mayo.edu.

Abstract

As the incidence of chronic kidney disease increases and women pursue pregnancy at more advanced ages, the management of kidney disease in pregnancy has become increasingly relevant to the practicing nephrologist. Women with kidney disorders face several challenges in pregnancy due to increased physiologic demands on the kidney and risk for disease progression, the potential teratogenicity of medications, and the increased risk for complications such as preeclampsia and preterm delivery. Challenges posed by an underlying disease process in pregnancy, such as autoimmune disease or diabetes mellitus, necessitate an interdisciplinary team to ensure good maternal and fetal outcomes. Rates of acute kidney injury in pregnancy are generally declining worldwide, but remain a significant public health concern in developing countries. Pregnancy may also be the first time that a woman has kidney disease or hypertension diagnosed. An understanding of what constitutes normal physiologic changes in pregnancy is critical in a diagnostic evaluation. In this review, we review physiologic changes in pregnancy, causes and management of acute kidney injury in pregnancy, hypertensive disorders of pregnancy, and how to care for women with chronic kidney disease of various causes, including the use of antihypertensives and immunosuppressants.

KEYWORDS:

Pregnancy; acute kidney injury (AKI); autoimmune disease; chronic kidney disease (CKD); diabetes mellitus; dialysis; hypertension; immunosuppression; kidney transplantation; maternal fetal complications; preeclampsia; renal disease; renal outcomes; review

PMID:
30122546
PMCID:
PMC6309641
DOI:
10.1053/j.ajkd.2018.06.006
[Indexed for MEDLINE]
Free PMC Article

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