Kidney Disease In Pregnancy


Pregnancy results in important alterations in acid-base, electrolyte, and renal function due to pregnancy-associated physiologic changes in renal and systemic hemodynamics. Understanding these changes is essential when evaluating pregnant women with or without renal disease. A pregnant women is at a high risk to develop kidney related complications ranging from simple urinary tract infection to acute Kidney Injury (AKI). AKI may occur due to reasons which are highly specified for pregnancy like pregnancy related hypertension, abruption placentae, acute fatty liver of pregnancy and HELLP syndrome (Hemolysis, Elevated liver enzymes, and low platelets) or it may occur due to blood loss or sepsis during or after the delivery. It must also be remembered that pregnancies in women with underlying chronic kidney disease who require dialysis during pregnancy or who have previously undergone renal transplantation pose unique sets of issues. Successful maternal and fetal outcomes for women with preexisting kidney disease, with kidney transplantation and those with onset of kidney disease during pregnancy, require a close working relationship among all physicians involved in the care of these patients. Obstetrical acute renal failure (ARF) is a rare entity in the developed world. The incidence has decreased from 43% (1956-1967) to 0.5% with respect to total ARF cases (1988-1994) and no case of maternal death or irreversible renal damage has been observed in last seven years in the United States of America. Moreover even this small number of obstetrical AKI in developed world are mostly because of reason like pregnancy related hypertension, abruption placentae, acute fatty liver of pregnancy and HELLP syndrome On the other hand, unfortunately the developing countries like Pakistan present a different picture and pregnancy related AKI ranges from 4% to 36% and mostly because of sepsis and blood loss during or after delivery. Data from Pakistan is scanty, but various studies showed high incidence of mortality (18% to 23%) and morbidity (13% to 26%) related to obstetrical ARF. One striking feature in studies from the developing nations indicate that the pregnancy related ARF is more commonly seen (86%) in patients who had not received any kind of antenatal care and their deliveries were carried out at home assisted without aseptic measures. Also in women delivered in hospitals not having received antenatal care were more prone to develop ARF (14%). This indicates the importance of antenatal care in the prevention of pregnancy related ARF. The industrialized nations and even some of the developing countries have achieved these goals by liberalization of abortion laws, improved healthcare facilities and more effective measures of careful prevention.