There is an increased incidence of chronic kidney disease (CKD) in patients with underlying rheumatic disease. For a proportion of patients, CKD is diagnosed for the first time in pregnancy through routine antenatal blood and urine testing. Pregnancy places increased physiological demand on the kidneys, and women with CKD have increased risks of adverse pregnancy outcomes, including pre-eclampsia (PET), pre-term delivery, and low birth weight babies. These risks increase incrementally with declining baseline renal function. Thorough pre-conception counselling and regular antenatal review by teams specializing in the care of renal and/or rheumatological conditions is recommended to mitigate these risks and optimize outcome for mother and baby. This chapter describes, through case-based discussion, the investigation and management of abnormal renal function presenting in pregnancy, pre-pregnancy counselling for women with CKD, and the principles of antenatal care for women with impaired renal function.
Studies on kidney function in pregnancy Jamada (Journ. of biochem., vol. 5, № 2, 1925)