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Pregnancy With Preexisting Kidney Disease - Complications and Management

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Pregnancy with pre-existing kidney disease is a challenging scenario as there is an increased risk of adverse outcomes. To know more, read the below content.

Medically reviewed by

Dr. Richa Agarwal

Published At November 4, 2022
Reviewed AtFebruary 7, 2024


Kidneys are the major organs involved in the filtration of the blood, maintaining the electrolyte and acid-base balance in the body. Any disease or disorder affecting the kidneys would definitely produce a big impact on the life of a person. It becomes even more difficult when a patient with improperly functioning kidneys gets pregnant. Pregnancy with pre-existing kidney disease is a challenging situation for both the patient as well as the physician because of the increased demand for the kidney for maternal blood filtration, the risk of teratogenicity of the drugs, and the increased chances of complications associated. Hence, the journey of pregnancy in those cases should be accompanied by an interdisciplinary team to ensure good maternal and fetal health.

What Does the Term Pregnancy Denote?

The term pregnancy indicates the period or the time in which the fetus develops inside the mother's womb or the uterus. It is usually calculated from the date of the last menstrual period and lasts about 40 weeks or nine months. The journey and the symptoms of pregnancy vary from person to person.

It is important to understand the normal physiological changes in pregnancy, as this would help in framing the diagnosis as well as the treatment modalities. The physiological, as well as anatomic changes in the woman's body start to appear during the early stages of the first trimester of pregnancy. A good understanding of the normal changes during pregnancy is important as this would help in framing the diagnosis as well as the treatment modalities.

What Are the Physiological Changes Seen in Pregnancy?

Various physiological changes occur during pregnancy, such as;

Hemodynamic Changes:

  • Increased cardiac output.

  • Decreased systemic blood pressure.

  • Decreased vascular resistance.

  • Increased nitric oxide levels in the blood.

  • Increased levels of relaxin in the blood.

  • Increased progesterone levels.

Volume Changes:

  • Increased plasma volume of 40 to 50%.

  • Increased total body water content.

  • Decreased plasma osmolality by 10 mOsm/kg.

  • Decreased plasma albumin.

Changes in Acid-Base Balance:

  • Increased blood pH 7. 42–7. 44.

  • Mild respiratory alkalosis.

  • Increased bicarbonate reabsorption.

  • Decreased serum hydrogen ion.

  • Decreased PCO2 (18 to 22 mEq/L).

Hormonal Changes:

  • The decreased osmotic threshold for thirst.

  • Increased metabolic clearance.

  • Increased levels of vasopressin, aldosterone, mineralocorticoids, etc.

  • Increased renal kallikrein excretion.

What Are the Physiological and Anatomical Renal Changes that Occur in Pregnancy?

  • Increased renal size and volume.

  • Dilatation of the collecting duct.

  • Ureteral connective tissue hyperplasia.

  • Ureteral smooth muscle hypertrophy.

  • Physiologic hydronephrosis can happen due to the enlarging uterus putting pressure on the kidneys.

  • Urine retention also happens due to hydronephrosis.

  • Increased urinary protein excretion (proteinuria) to a range of 180 to 250 mg/day.

  • A 50% increase in glomerular filtration rate happens in the second trimester. This results in hyperfiltration, thereby reducing the serum creatinine levels to a range of 0.4 to 0.6 mg/dl.

  • A 50 to 80% increase in renal blood flow.

  • Decrease in renal vascular resistance.

  • Hyperfiltration of sugar, amino acids, vitamins, proteins, etc.

  • Positive sodium balance.

What Are the Complications of Pre-existing Kidney Disease in Pregnant Women?

Studies report that the incidence of women getting pregnant with pre-existing renal diseases has increased in recent years, with a reported incidence of 15,000 to 20,000 pregnancies per year in England. The most common cause of chronic kidney disease in those patients is attributed to the fact that women pursue pregnancy at more advanced ages. Although pre-existing kidney disease is not an obstacle to reproduction in women, it is associated with high chances of maternal and fetal complications. Research shows that women under dialysis for more than a year would lose their ability to become pregnant as their menstrual cycle becomes irregular or absent.

The most common kidney diseases reported in pregnant women include:

How Does Hypertension Affect Pregnant Women With Pre-existing Kidney Disease?

Women with a known history of hypertension prior to pregnancy are at increased risk of developing preeclampsia (a condition in which the blood pressure value is greater than 140/90 mmHg). This preeclampsia, in turn, would result in proteinuria (increased excretion of protein in the urine of more than 300 mg/day) and increased serum creatinine concentration.


  • Impaired angiogenesis (blood vessel formation) in the fetus.

  • Seizures may develop in mothers in cases of uncontrolled hypertension.

  • Fetal death.

  • Preterm delivery.


  • Reduce the salt intake.

  • Use of Antihypertensives (to control blood pressure levels).

  • Emergency C-sections are indicated in cases of severe preeclampsia to prevent fetal complications.

  • Full-term delivery in cases of mild and controllable hypertension.

What Are the Complications of Lupus Nephritis in Pregnant Women?

  • The occurrence of systemic lupus erythematosus (SLE) in the kidney is called lupus nephritis. It is mainly due to the immunological changes that occur in the body resulting in the production of autoantibodies. Women with a known history of lupus nephritis should take advice from their physician prior to conception, and they should have at least a six-month quiescent period prior to pregnancy.

  • Studies report that the patients with renal symptoms demonstrated anti-DNA antibodies and low C3 levels. Patients who developed lupus nephritis in the second and trimester of pregnancy demonstrated low C4 levels and high anti-C1 q antibodies.


  • Diagnosis of this condition is established by the detection of antinuclear antibodies in the patient's serum.


  • High risk of preterm delivery.

  • High chances of developing preeclampsia.

  • The estimated overall mortality rate is one percent.


  • Close Monitoring - Patients should be monitored carefully to diagnose any disease flares and to prevent further adverse complications.

  • Medications - Safer drugs should be prescribed to prevent any adverse effects. Drugs such as Hydroxychloroquinone and Azathioprine can be used to suppress the autoantibodies.

  • Renal Function Tests and Biomarkers - Should be used often to check whether the disease is under control.

What Are the Complications of IgA Nephropathy in Pregnant Women?

IgA nephropathy is characterized by the deposition of IgA antibodies in the kidney, affecting normal kidney function.



Patients with mild IgA nephropathy usually do not require any treatment; in patients with severe disease conditions, safer immunosuppressive agents should be prescribed.

What Are the Complications of Chronic Kidney Disease in Pregnant Women?

Chronic kidney disease is characterized by the improper functioning of the kidneys, which lasts for a longer period of time. Women with an antepartum renal disease with serum creatinine levels of more than 2 mg/dl are at a higher risk of renal failure.


It may occur as a result of pre-existing diseases such as diabetes, lupus nephritis, hypertension, etc.


  • Decreased renal function.

  • Preeclampsia.

  • Preterm delivery.

  • HELLP syndrome (It is a serious complication of pregnancy that mainly affects the blood and the liver).

  • Still birts.

  • Miscarriages.

  • Neonatal death.

  • Low birth weight.


The main aim of treatment is to treat the underlying disease to prevent the further progression of renal disease. The patient should be informed priorly to the complications of pregnancy with the pre-existing renal disease. Careful monitoring and neonatal care would help improve the survival rates.

What Are the Complications of End-Stage Renal Disease (ESRD) in Pregnant Women?

Pregnant women with the end-stage renal disease require dialysis. Studies report that patients under dialysis have diminished fertility rates due to irregular or absent menstrual periods. However, during the first year of dialysis, the chances of women getting pregnant are comparatively high.


  • ESRD in pregnant women is a rare complication, but if it occurs, it can be caused due to underlying systemic diseases such as poorly controlled diabetes, hypertension, lupus nephritis, autoimmune conditions, etc.



Intensive dialysis is the mainstay of treatment in pregnant women with end-stage renal disease.


Pregnancy with pre-existing kidney disease is a major challenge to both the patient as well as the medical care provider. Women with pre-existing kidney disease should consult their respective care providers and take their advice before planning the pregnancy. Certain medical conditions need prophylactic measures before pregnancy that should be followed strictly to improve maternal and fetal incomes.

Frequently Asked Questions


What Is Pre-existing Kidney Disease and How Does It Affect Pregnancy?

Preexisting kidney failure happens due to poor blood supply to nephrons, limiting waste filtration due to high energy demand. These issues can complicate pregnancy, requiring the management of conditions like anemia and hypertension before conception. Dialysis during pregnancy is possible but risky; consult the healthcare team for guidance.


What Are the Risks of Pregnancy With Pre-existing Kidney Disease for the Mother and the Baby?

Pregnant women with kidney disease are more likely to face issues like:
- High blood pressure during pregnancy.
- Slow fetal growth.
- Having the baby too early.
- Needing a C-section.
- End-stage renal disease.


How Can I Prepare for Pregnancy if I Have Preexisting Kidney Disease?

Women with kidney disease should know the risks to their kidneys and the baby before pregnancy. Take 400 µg (microgram) of folic acid daily before and during the first 12 weeks of pregnancy. Start low-dose aspirin early in pregnancy to reduce pre-eclampsia risk.


How Often Should I See My Doctor During Pregnancy if I Have Preexisting Kidney Disease?

A person should visit a doctor if they find:
- The blood sugar levels are consistently off-target.
- The baby’s movement is less in the belly.
- Vision becomes blurry.
- Feeling unusually thirsty.
- Experiencing persistent nausea and vomiting.


What Tests and Treatments Will I Need During Pregnancy if I Have Preexisting Kidney Disease?

Various tests and treatments are needed to ensure a healthy pregnancy during preexisting kidney disease.
 Kidney function tests.
- Preoteinuria testing.
- Ultrasound scans.
- Medication adjustments.
- Dietary changes.
- Regular blood pressure monitoring.
- Blood sugar monitoring.
- Frequent prenatal checkups.


How Can I Manage My Blood Pressure and Proteinuria During Pregnancy if I Have Preexisting Kidney Disease?

If a pregnant woman has over 3 grams of protein in her urine for 24 hours, she might get a medication called low molecular weight heparin. It prevents blood clots during and after pregnancy for about six weeks. It protects her and her baby.


What Are the Signs and Symptoms of Preeclampsia and How Can I Prevent It if I Have Preexisting Kidney Disease?

- Very high blood pressure (160/110 mmHg or higher).
- Kidney or liver problems.
- Fluid in lungs.
- Low blood platelet levels.
- Reduced urine output.


How Can I Monitor My Baby’s Growth and Well-Being During Pregnancy if I Have Preexisting Kidney Disease?

For pregnant women with pre-existing kidney disease, it is better to have scans in the third trimester to check the baby’s growth and health. This helps to ensure the baby is doing well in the later stages of pregnancy.


What Are the Best Delivery Options and Timing for Me and My Baby if I Have Preexisting Kidney Disease?

Delivery decisions for pregnant individuals with pre-existing kidney disease depend on their health, gestational age, and fetal well-being, with options including vaginal or C-section delivery. Close medical monitoring and open communication with healthcare providers are essential for a safe delivery plan.


How Can I Cope With the Emotional and Physical Challenges of Pregnancy With Preexisting Kidney Disease?

Coping with pregnancy and kidney disease includes seeking emotional support, maintaining medical care, and managing stress while adopting a healthy lifestyle.


What Are the Possible Complications After Delivery if I Have Preexisting Kidney Disease?

Women with preexisting kidney disease can face a high risk of losing the baby, premature delivery or intrauterine growth retardation. These risks are even greater if they develop kidney problems suddenly, experience nephrotic syndrome, or have high blood pressure during pregnancy.


How Can I Protect My Kidney Function After Delivery if I Have Preexisting Kidney Disease?

Protect kidney function after delivery with regular check-ups, blood pressure control, and a healthy lifestyle guided by healthcare providers.


How Will Breastfeeding Affect My Kidney Function and Medication if I Have Preexisting Kidney Disease?

Breastfeeding can impact kidney function and medication for those with preexisting kidney disease. Consult the healthcare team for personalized guidance.


When Can I Plan for Another Pregnancy if I Have Preexisting Kidney Disease?

For women who have had a kidney transplant, it is usually advisable to wait 1 to 2 years before attempting pregnancy. They can plan for pregnancy once the risk of organ rejection is low and stable kidney function is afflicted.


How Can I Prevent or Delay the Progression of My Kidney Disease After Pregnancy?

Follow a kidney-friendly diet that suits one’s taste with the help of a dietitian, and stay active to manage the kidney condition. Consult the doctor about adding exercise to the daily routine.


What Are the Different Types of Preexisting Kidney Disease and How Do They Affect Pregnancy Differently?

Expect preterm birth and early preeclampsia risk with lupus and kidney inflammation during pregnancy. The maternal mortality rate is roughly 1 percent.


How Does Dialysis or Transplantation Affect Pregnancy Outcomes if I Have Preexisting Kidney Disease?

Kidney disease and pregnancy need careful management. Dialysis patients face reduced fertility and more complicated pregnancies, including hypertension, anemia, miscarriage, excess amniotic fluid, early birth, and baby growth issues.


How Does Diabetes or Lupus Affect Pregnancy Outcomes if I Have Preexisting Kidney Disease Along With These Conditions?

Women with lupus and kidney inflammation are more likely to have their babies early and develop preeclampsia sooner compared to those with lupus but with no kidney inflammation.


What Are the Best Dietary and Lifestyle Choices for Me and My Baby if I Have Preexisting Kidney Disease?

A diet good for your kidneys should cut down on salt, cholesterol, and fat, and instead, emphasize fruits, veggies, whole grains, low-fat dairy, and lean proteins like fish, chicken, eggs, beans, nuts, seeds, and soy products.
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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology


pregnancy complicationskidney disorderspregnancy
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