A lot of women have questions about pregnancy and kidney disease so I am going to cover some of the most frequently asked questions about pregnant women & kidney failure.

Can pregnancy led to kidney failure? Yes
In fact some women are fine and not aware of kidney disease until they are pregnant. The diagnosis is new, shocking, and often family members blame the doctors for the complications of the pregnancy. The disease does not even appear until during the pregnancy. Diseases like lupus, hypertension or heart failure.

What is Lupus?
Systemic Lupus Erythematosus (SLE). Your body’s immune system recognizes ITSELF as being foreign and begins to attack it. Systemic – any and all of your various systems in the body. The brain, lungs, heart, kidneys and unfortunately the uterus as well. The damage so devastating that the mom needs dialysis and the poor baby won’t know what hit him/her. No blood flow to the uterus…well you can figure that one out!

Preeclampsia or hypertension can exist during pregnancy?
There is that word ‘high blood pressure’ again. A more serious manifestation of preeclampsia is Thrombotic thrombocytopenic Purpura (TTP). “Thrombo who?” A disease that messes with the clotting mechanisms in your body. Women can have seizures as well as kidney disease. This is life threatening to the mother. Plasmapheresis (a process to filter out the abnormal proteins in your blood) may be needed as well as dialysis! In these situations the baby must be delivered early or terminated in order to save the mother.

Other kidney disease that affect mom while pregnant:
Cardiomyopathy can lead to congestive heart failure (CHF). Still want to get pregnant? The CHF is such that less blood is able to be pump out from the heart into the other parts of the body. Therefore, decrease blood flow to the kidneys. If the decrease of blood flow is significant and last long enough in duration, damage to the renal arteries occurs, hence dialysis. Pregnant women often feel tired and short of breath. Wouldn’t have even imaging the strain on their heart has unmask a more serious heart condition. Exercise, exercise! And the importance of prenatal visits!

These are just some of the conditions that can cause kidney failure & pregnancy.

It is very risky for the mother to attempt another pregnancy until the disease is well controlled with medications. And the medications usually are toxic (list in next section) to the baby! FYI since most of these illnesses have hypertension associated with them, one class of blood pressure (BP) pills to avoid is ace inhibitors/angiotensin rennin blockers (ACEIs)/ARBs. For example, lisinopril, enalapril, vasotec, cozaar, diovan, hyzaar—are associated with birth defects. Fetus has no kidneys!

Can patients with kidney transplants have children?
Yes, beautiful healthy children!

A transplanted male, with a blood *creatinine level of ~2.0 or less (normal is 1.0 mg/dl), will be just as fertile as a normal male. And a transplant female can carry a baby close to term as long as she has a transplant kidney that is as close to normal (0.8 mg/dl) as possible. Serum creatinine is another way to measure one’s kidney function.

* Creatinine comes from skeletal muscle and is filtered easily by a normal working kidney. Therefore a easy test to order and measure your kidney status.

Are the medicines safe for the baby?
Drugs taken to maintain a transplanted kidney will cross into the placenta. Everything mom puts on her skin, in her mouth pretty much will cross there and/or get into her breast milk. Drugs like steroids, cyclosporine, tacrolimus, mycophenolate mofetil can be toxic to the fetus, especially in high doses. That’s why a transplanted patient whose kidney is as close to normal as possible ( for ~ 2 years into the transplant there are no problems with illness/no rejection ), requires less of these toxic medicines. At most, the baby is born a little earlier and weighs a little less than normal.

What stage of chronic kidney disease affects a women’s ability to have children?
None if they follow their doctor’s advice.

Pregnancy and on dialysis?
Usually women who are of childbearing years, started dialysis within the last 2-3 months, good BP control and adhere to a dialysis regimen, do not lose their sexual drive and have the ability to get pregnant. Again dialysis is started at stage 5 , GFR/kidney function at 15% or less.

Is it safe to have kids on dialysis?
Well premature delivery is the rule rather than the exception in women on dialysis. There may be some advantages to peritoneal dialysis versus hemodialysis. But a hemodialysis pregnant patient must come to dialysis 6 days a week. She must take prenatal vitamins high in folic acid. Receive shots to prevent anemia. Have her BP perfect and eat frequent yet balance/healthy meals for the baby. Fresh fruit, colorful salads, plant seeds (flax, sunflower), and nuts with every meal. That’s right. The fluid, protein, potassium, phosphorus restrictions are not going to be a major problem. The baby needs good nutrition. And the daily dialysis keeps the poisons/uremia from building up in mom!

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