Any family will rejoice with the arrival of a new baby. However, pregnancy puts a lot of strain on your body. You and your unborn child’s health may be jeopardized if you have renal disease or kidney failure. Women with renal illness who conceive and carry a pregnancy are at a high risk of having a difficult pregnancy. 

Despite advancements in prenatal and neonatal treatment, the risks remain proportional to the degree of underlying renal impairment. Compared to women with normal kidney function, women with substantial chronic kidney disease (CKD), particularly those with advanced CKD, are considerably less likely to become pregnant or have an uncomplicated pregnancy. Even moderate CKD is linked to an increased risk of adverse maternal and fetal outcomes, such as deteriorating renal function, proteinuria, and hypertension, as well as preterm delivery and fetal growth restriction.

Are you considering becoming a mother?

If this is the case, try discussing it with your doctor or other healthcare practitioners ahead of time. They are familiar with you and can assist you in making a decision that is based on your individual health. There are several factors to consider. You and your doctor should go through each one thoroughly. A healthy pregnancy can be influenced by several factors, including:

• Your kidney disease stage
• Your overall well-being
• Your age
• High blood pressure, diabetes, or heart disease
• Having additional major medical issues
• Urine with protein

Here are the answers to some frequent kidney illness and pregnancy related inquiries.

Is it possible for a woman with “mild” renal impairment to have a child?

• That is debatable. 
• Women with minor renal impairment (stages 1-2), normal blood pressure, and little or no protein in the urine (called “proteinuria”) can have a safe pregnancy, according to the data. 
• Proteinuria is a disease in which the body produces too much protein, a symptom of renal disease. Your body requires protein, but it should be in your blood rather than your pee. Protein in the urine indicates that your kidneys cannot filter your blood properly, and the protein is seeping out.
• The risk of problems is substantially higher in women with moderate to severe renal dysfunction (stages 3-5). For some women, getting pregnant at this stage is so significantly risky that pregnancy should be avoided.
• Ask your doctor or other healthcare providers about your stage of kidney disease, your risk of problems, your degree of proteinuria, and any other health concerns you may have if you’re thinking about getting pregnant.

Is it possible for a patient undergoing dialysis to have a child?

• Some changes in your body make it difficult to conceive. 
• Most dialysis patients, for example, suffer from anemia (low red blood cell count) and hormonal abnormalities. 
• They may not be able to have regular menstrual cycles due to this.
• In most cases, women with renal failure are recommended not to get pregnant. 
• Complications occur at an alarmingly high rate. The mother and the baby, both are at risk. 
• If you’re thinking about starting a family, consult your doctor. 
• To have a healthy baby, you will require constant medical supervision, modifications in medicine, and additional dialysis if you get pregnant.

Is it possible for a woman who has had a kidney transplant to have a child?

Yes. 

• If you’ve had a kidney transplant, you’re more likely to have regular periods and be in excellent health overall. 
• As a result, it is possible to become pregnant and have a kid. 
• Even if your kidney function is stable, you should wait at least a year after your transplant before getting pregnant.
• After a kidney transplant, some medications that you take might harm an unborn child. 
• Pregnancy may not be suggested in some situations due to severe danger to you or the baby. 
• Another issue is if the transplant is at risk of failing.
• If you have a transplant and consider getting pregnant, talk to your doctor. 
• Your healthcare professional may need to adjust your prescriptions to make it safe for you to get pregnant. 
• It is essential to use birth control until you and your healthcare professional have decided that becoming pregnant is safe.

What effects may transplant patients’ medications have on an unborn child?

• Many anti-rejection medications are safe for a pregnant woman and her unborn child. 
• However, some kinds might impact the pregnancy and the baby. 
• These should be avoided during pregnancy and should be stopped at least six weeks (or more) before conception. 
• After you’ve stopped, your doctor will most likely keep a check on you and let you know when it’s safer to try for a baby.
• If you have had a kidney transplant and are thinking about getting pregnant, talk to your transplant team and your renal specialist first. 
• Your nephrologist may tell you to switch to a different anti-rejection medication.

Is it possible for a man on dialysis or who has had a kidney transplant to father a child?

Yes. 

• Men on dialysis or who have had a kidney transplant can father children. 
• Consult your doctor if you’ve been trying to father a kid for a year or longer without success. 
• A routine reproductive exam may benefit a guy with renal disease or kidney failure. 
• In addition, several post-transplant drugs might impair a man’s capacity to father children. 
• If you’ve had a transplant and want to start a family, talk to your doctor about your options.

For renal patients, what type of birth control is recommended?

• Patients on dialysis and transplant who are sexually active and have not reached menopause should take birth control to avoid becoming pregnant. 
• Your healthcare professional can advise you on birth control to use. 
• Many women with high blood pressure should avoid using “the pill” (oral contraceptives), as it might elevate blood pressure and increase the risk of blood clots. 
• When used with spermicidal creams, foams, or jellies, the diaphragm, sponge, and condom are typically effective birth control methods. 
• It’s also feasible to use a newer IUD.

Kidney illness affects a woman’s life in a variety of ways. However, this does not negate her desire to have a child. Pregnancy and renal illness are equally taxing on the body. Diabetes, lupus, and persistent high blood pressure are illnesses that impact kidney function.

On the other hand, pregnancy with renal illness might have severe consequences for a patient’s current and future health. Complications such as hypertension, fetal development restriction, premature birth, and the requirement for a cesarean section are more likely in women with chronic renal disease (C-section). 

A specialist care team must carefully address these issues, including a nephrologist and a doctor specializing in maternal-fetal medicine (MFM).

Precautions to take if you’re pregnant and have renal disease:

• Before becoming pregnant: You may have had kidney problems. If you have a renal illness, we’d want you to meet your nephrologist before you get pregnant. Kidney problems are linked to an increased risk of fetal issues like preterm delivery and pregnancy loss. After pregnancy, some women with moderate to severe kidney illness develop end-stage renal disease. Patients are also at a higher risk of developing iron-deficiency anemia, having low vitamin D levels, and having high blood pressure. Before pregnancy, your nephrologist and MFM can help you get your red blood cell, vitamin D, blood pressure, and blood sugar levels to safe levels, reducing risks to both you and the baby.
• If you received a kidney transplant: We usually advise women to wait for one to two years following a kidney transplant before trying to conceive. Once a patient’s risk of organ rejection has been determined to below, and their kidney function has been confirmed to be stable, they can safely consider pregnancy. Pregnancies following a kidney transplant have a greater chance of succeeding than pregnancies while on dialysis. Continue to monitor your blood pressure and discuss your rejection drugs with your nephrologist. Many of these medications are safe to use during pregnancy, but some might cause birth abnormalities or other issues. Your medical team can assist you in finding a safer option, ideally before you get pregnant.
• If you are diagnosed with kidney complications during pregnancy: Other health disorders, aside from renal illness, might cause kidney problems during pregnancy: 

• Infections: Asymptomatic bacteriuria is a urinary system infection that causes no symptoms. It might progress to a kidney infection if left untreated (pyelonephritis). In most cases, kidney infections necessitate hospitalization and IV antibiotic treatment. Pregnant women are particularly susceptible to complications, including breathing difficulties for the mother and premature birth.
• Kidney stones: The risk of kidney stones does not rise during pregnancy. 
• The dilatation of the ureter that occurs during pregnancy, on the other hand, may make it simpler for you to pass stones. Hydration and over-the-counter pain relievers are commonly used to treat the condition.
• Pre-eclampsia: High blood pressure during pregnancy is linked to decreased kidney function and premature delivery. 
• We examine for high protein levels in the urine because it might be a symptom of preeclampsia. That’s why we ask for so many urine samples during prenatal checkups near the conclusion of your pregnancy.
• Acute kidney injury (AKI) or rapid renal failure can occur in patients who bleed or have placental abruption. Thankfully, the management of these disorders has improved, and AKI is no longer a prevalent occurrence.

What is the best way to manage chronic renal disease during pregnancy?

• All women with chronic renal disease should be sent to an obstetrician and, if required, additional specialists early in their pregnancy to organise their prenatal treatment.
• Regular monitoring of maternal renal function (serum creatinine and serum urea), blood pressure, midstream urine (for infection), proteinuria, and, when necessary, ultrasound (to detect urological obstruction) should detect pathological changes and allow for timely intervention to improve perinatal and maternal renal outcomes.

Before Pregnancy:

• Before they conceive, all women with chronic kidney illness should be informed about the dangers to their long-term renal function and the fetus. 
• Amenorrhoea is common in women with chronic renal illness, but they can still ovulate and conceive occasionally. 
• Those who do not want to become pregnant should use contraception that considers clinical comorbidities.

During Pregnancy:

• Chronic kidney disease can manifest itself in various ways, and prenatal surveillance should be adjusted to the severity of the illness and its implications. 
• In general, as the pregnancy develops or if changes imply poor kidney function, all clinical and biochemical characteristics should be examined more often. 
• Although specialist treatment should begin early in pregnancy, general care providers may perform most of the monitoring for women with stage 1-2 illness.

Postpartum Care

• The physiological changes of pregnancy can last up to three months and, in some cases, much longer. 
• Close monitoring of fluid balance, renal function, blood pressure, and a re-evaluation of medication therapy will be required during this period. 
• Women with pre-eclampsia who have new-onset proteinuria should be monitored until it goes away or a diagnosis of renal illness is obtained.
• In women with chronic renal illness, breastfeeding should be promoted. 
• It’s still unclear if the benefits of breastfeeding are offset by immunosuppressive medicine absorption in the newborn period. 
• As long as the infant is flourishing, we typically urge moms who wish to breastfeed but are on immunosuppressive medicines to do so.

What is the treatment for kidney infections during pregnancy?

• If a pregnant woman has a kidney infection during her pregnancy, she will need to go to the hospital for treatment. 
• Antibiotics and intravenous fluids will be used in this therapy. 
• Antibiotics used for a short period are unlikely to damage a growing fetus.

Pregnancy causes significant acid-base, electrolyte, and kidney function changes due to physiologic changes in renal and systemic hemodynamics. It’s critical to understand these alterations when examining pregnant women with renal illness. Pre-eclampsia, fetal growth restriction, premature birth, and decreased maternal renal function are risks women with CKD face during pregnancy.

A kidney infection can cause the following signs and symptoms:

• Fever.
• Chills
• Pain in the back, side (flank), or groin.
• Pain in the abdomen.
• Frequent urination
• The urge to urinate is persistent and constant.
• When urinating, there is a burning feeling or discomfort.
• Nausea and vomiting are common side effects.