Is pregnancy risky with reduced kidney function at 41?

Question

Hi doctor,

I am 41 years old and have polycystic kidney disease that I inherited from my mom, who died from kidney failure at age 58. My kidneys are covered with cysts - the largest one is 8 cm and is causing constant pain in my right side. My GFR has dropped from 65 to 42 mL/min in just 18 months, and creatinine is up to 1.9 mg/dL. The nephrologist says I am heading toward dialysis within five to ten years. I tried Tolvaptan, which is supposed to slow down cystic kidney disease progression, but it gave me terrible thirst, and my sodium went up to 150 mEq/L so I had to stop. My blood pressure is really hard to control, even on Lisinopril 40 mg and Amlodipine 10 mg - it is usually around 155/92 mmHg. The worst part is I am only 41 and want to have another child, but my gynecologist says pregnancy could make the kidney disease progress faster. I already have two kids, aged 8 and 5, who both got tested, and my daughter has the PKD1 gene mutation too, which breaks my heart. I developed anemia with hemoglobin at 9.8 g/dl and chronic fatigue that makes working full-time almost impossible. Also, having frequent UTIs and kidney stones from the cysts. Is it too risky to get pregnant with cystic kidney disease at this stage? What can I do to slow down the progression?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for sharing your concerns.

Pregnancy is very high-risk with your current kidney function - glomerular filtration rate (GFR) 42 mL/min/1.73 m². It could cause a rapid decline in kidney failure. To slow progression and manage now:

1. Aggressive blood pressure (BP) control: Your current value, 155/92 mmHg, is too high. You need tight control (less than 120/80) to protect your kidneys. You may need additional medications (e.g., Labetalol is safe for future pregnancy).

2. Manage anemia: Treat iron deficiency and start an erythropoiesis-stimulating agent (ESA) if needed.

3. UTI (urinary tract infection) prevention: Use low-dose prophylactic antibiotics to prevent UTIs that damage the kidneys.

4. Diet: Very low sodium (less than 2g/day), avoid NSAIDs (nonsteroidal anti-inflammatory drugs).

5. Pain management: Consult a pain specialist for the 8 cm cyst; consider cyst drainage or surgical removal.

Future pregnancy:

Requires strict preconception control (BP, stable GFR).
You must see a maternal-fetal medicine specialist and a nephrologist for planning. Pregnancy may require stopping some medications.
Consider preimplantation genetic diagnosis (PGD) to select an embryo without the PKD1 (polycystic kidney disease 1) gene for your daughter's future.

So, focus aggressively on preserving kidney function now. Pregnancy is not impossible, but it is extremely risky at your current stage and requires meticulous planning with high-risk obstetrics and nephrology.

I hope this answers your query.

Thanks and regards.