Chronic renal disease and pregnancy

A challenge in clinical care and obstetric outcome

Abstract

Pregnancy is a physiological state in which multiple adaptations occur in the cardiovascular, immune and renal systems in order to meet metabolic demand and protect the fetus. Kidney disease can be manifested or discovered incidentally during pregnancy and can be seen from three clinical scenarios: the development of acute kidney injury, the diagnosis of chronic kidney disease (prior undiagnosed nephropathy) and the known antecedent (underlying nephropathy) of chronic kidney disease preceding pregnancy. Whatever the scenario, the presence of chronic kidney disease darkens the fetal prognosis, increases the risk of intrauterine growth retardation, premature delivery, stillbirth and accelerates the loss of renal function of the pregnant woman so it constitutes a challenge in clinical care. For this reason the early recognition and initiation of therapy is essential to impact on maternal and fetal outcome. Although this association has been described for several years and the obstetric outcome has improved in the past two decades, it remains an entity with high morbidity and mortality for mother and child. In this work, eight cases of chronic kidney disease and pregnancy, clinical presentation and obstetric outcome are describ