gynecology and obstetrics
Renal Insufficiency in Pregnancy
Introduction
Renal disorders often do not worsen during pregnancy; noninfectious renal disorders are usually exacerbated only when uncontrolled hypertension coexists. However, significant renal insufficiency (serum creatinine>3 mg/dL [>270 micromol/L] or bloodureanitrogen [BUN]>30 mg/dL [>10.5 mmolurea/L]) before pregnancy usually prevents women from maintaining a pregnancy to term. Maternal renal insufficiency may cause Small-for-Gestational-Age (SGA) Infant None Stillbirth None After Kidney Transplantation , full-term, uncomplicated pregnancy is often possible if women have all of the following: A transplanted kidney that has been in place for>2 years Normal renal function No episodes of rejection Normal blood pressure (BP) Treatment of renal insufficiency during pregnancy requires close consultation with a nephrologist. BP and weight are measured every 2 weeks; BUN and creatinine levels plus creatinine clearance are measured often, at intervals dictated by severity and progression of disease.Furosemideis given only as needed to control BP or excessive edema; some women require other medications to control BP. Women with severe renal insufficiency may require hospitalization after 28 weeks gestation for bed rest, BP control, and close fetal monitoring. If results of antenatal testing remain normal and reassuring, the pregnancy continues. Delivery is usually required before term because preeclampsia, fetal growth restriction, or uteroplacental insufficiency develop. Sometimes amniocentesis to check fetal lung maturity can help determine when delivery should be done; a lecithin/sphingomyelin ratio of>2:1 or presence of phosphatidylglycerol indicates maturity. Cesarean delivery is very common, although vaginal delivery may be possible if the cervix is ripe and no impediments to vaginal delivery are evident. 