Can Women with Kidney Disease Get Pregnant? | Dialysis, Transplant & Pregnancy - Doctors' Circle

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So, can women with kidney diseases conceive? Kidney diseases, as we know, can be of many types. They can be of sudden onset or acute onset, and they can be of chronic onset, which has been prolonged for many, many years. So, what are the types of kidney diseases? There can be certain conditions which have been precipitated, let’s say, by dehydration, by a certain drug, by a change in position, or maybe the use of a temporary medication. These would fall under something called prerenal. There are certain specific kidney diseases which are because of some pathology inside the kidney, maybe in the glomerulus, maybe in the blood supply of the kidney, maybe in the tubules of the kidney, which are actually causing filtration and formation of the urine. Now, these conditions are the ones which have to be properly diagnosed, and some of them may even require a kidney biopsy or a renal biopsy for their diagnosis. There are also certain conditions which occur outside of the kidney, however, in the body, which are called extrarenal. Those can be in the form of stones. There can be a lymph node in the abdomen pressing on your ureter. It can be a small structure. It can be a cervical lesion, like a cervical fibroid or a cervical polyp, which is causing back pressure into the kidney. It can be a small stricture in the urethra, which is the last part of your urinary evacuation. Now, all these kidney diseases affect our serum creatinine levels, which happen to be the most important marker for an obstetrician to decide whether you can actually conceive or not. It is believed that 0.9 mg per deciliter is the highest upper limit of a safe level of creatinine in a lady who wants to conceive or has conceived. So, as a routine, we would like to always perform a serum creatinine test in a lady who’s come to me for preconceptional counselling or early in her pregnancy, so I can monitor. Now, what happens if this goes out of range? Now, if creatinine goes out of range, my most dreaded complication would be an abnormal rise in blood pressure. That is called preeclampsia. So, most of these patients who have chronic kidney disease would already be on certain antihypertensives for the control of their blood pressure. So, this condition becomes preeclampsia superadded on a chronic hypertensive disorder, again, a relatively serious condition.
A condition which requires us to carefully monitor you throughout your pregnancy. A condition where you actually may be warranted to undergo preterm labour or a preterm delivery, if, in such a condition, with serial growth scans along with our fetal medicine team, we find out that the growth of the baby starts lagging. So, these are the mothers who actually end up having early deliveries, preterm deliveries, owing to two things, either growth restriction in the baby because the blood supply to the baby is hampered in view of the kidney disease, or the mother herself develops high blood pressure or anemia which warrants us to save the life of the mother or not to deteriorate it further. Pregnancy again is a very taxing condition on the kidneys, as the blood supply and the filtration process in pregnancy are absolutely increased. Now, in such patients who already have a compromised renal function, it becomes very imperative for an obstetrician to be very, very careful when allowing a pregnancy to occur in kidney disease. So, the end crux being, if you have a kidney disease, you need to be in regular touch with your physician, with your obstetrician, with your nephrologist, and then it should be a combined decision of the obstetrician and her treating team to allow you to get pregnant. There is another class of women who have probably donated a single kidney, let’s say, to their husbands, dads, or relatives.

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