Kidney failure, also called renal failure, can be a serious complication during pregnancy. Whether it is a preexisting condition or is first diagnosed during pregnancy, kidney disease can cause problems for both the mother and the baby.
Your kidneys are the organs that filter waste products from your blood, create hormones that regulate your blood pressure, an regulate electrolytes. They also clear out medications and drugs from your body. Your kidneys also regulate the amount of fluid in your body.
Kidney failure does not necessarily mean that your kidneys do not work at all. You may have mild or moderate kidney failure, which means that your kidneys are still working somewhat. Acute kidney failure is a sudden impairment of your kidney function that may clear up with treatment. Chronic kidney failure is long-term or permanent impairment. If your kidneys do not work at all or work only little, it is called end-stage renal disease. Chronic kidney disease is often divided into stages from mild to severe. Kidney function that is close to normal may be stage 1 or 2, while end-stage renal disease is stage 5.
A report in the journal BMJ estimated that around one in 750 pregnancies are complicated by moderate to severe kidney failure.
Two common causes of chronic kidney disease are diabetes and high blood pressure. Other causes include urinary tract infections that have spread to the kidneys or inherited conditions like polycystic kidney disease. Smoking, being obese, and having a family history of kidney disease are other risk factors.
Many people with mild chronic kidney disease may not know they have it because symptoms may be mild or be absent completely. Kidney disease is diagnosed by testing urine and blood samples. Checking for kidney problems is one reason your obstetrician or midwife asks you to provide urine samples often during your pregnancy.
If lab results on your blood and urine show signs of kidney failure, your healthcare provider may have you undergo an ultrasound examination of your kidneys. This can help determine what is causing your kidneys to malfunction.
Because mild or moderate kidney disease may have no or few symptoms, a woman might not know there is a problem before she becomes pregnant. But the extra strain of pregnancy can worsen kidney problems in a woman who has had no previous symptoms. If you were previously diagnosed with chronic kidney disease, or if you have just been diagnosed, your obstetrician or midwife will closely monitor your kidney function. Your obstetrician may work closely with other medical specialists, such as a nephrologist, which is a physician who specializes in treating the kidneys. You will probably need to continue monitoring the health and function of your kidneys after your pregnancy.
Women with chronic kidney disease are at greater risk for developing preeclampsia because the kidneys help control blood pressure. This rise in blood pressure in turn hurts the kidneys further and cause them more impairment. Preeclampsia can increase the risk of stroke or lead to eclampsia, a very serious condition that can cause seizures and other problems.
Other problems associated with poor kidney function during pregnancy include anemia and high potassium levels. The baby may also not grow as well when the mother has poor kidney function, resulting in a low birth weight or prematurity. Preeclampsia increases the risks or premature separation of the placenta from the side of the uterus and premature birth.
Women with end-stage renal disease, the most severe form, often have difficulty in getting pregnant and, if they become pregnant, they may have problems with maintaining their pregnancy. People with end-stage renal failure are usually treated with dialysis or with a kidney transplant. A woman who has had a kidney transplant can safely become pregnant and give birth if she has normal kidney function and normal blood pressure, and if it has been more than a year since her transplant, according to the National Kidney Foundation.
If you have poor kidney function during your pregnancy, your healthcare provider may prescribe medications to help control blood pressure, along with other treatments including vitamin D and calcium. You may also be prescribed a diuretic, which is a medication that increases your urine output.
If you have been diagnosed with kidney disease during your pregnancy, follow your healthcare providers instructions carefully. Call your obstetrician or midwife immediately if you develop swelling in your hands, feet, and face, or if any swelling suddenly gets worse, or if you experience nausea or vomiting.