Kidney disease and high risk pregnancy are linked as kidney disease increases the pregnancy risk factor for two reasons: First, it is often associated with development of pre-eclampsia (fluid retention and hypertension). Secondly, if kidney infection such as pyelonephritis develops, it tends to flare up during pregnancy, which makes it much more difficult to treat.
Kidney disease in pregnancy is associated with premature rupture of membranes, premature birth and a high infant mortality. To prevent this from happening a pregnant woman with a history of kidney disease is monitored more closely with regular urine cultures and longterm suppressive antibiotic therapy. Women who had established kidney disease with a pregnancy in the past, will have to be hospitalized at 28 weeks for close fetal monitoring.
A stress test utilizing oxytocin can be done to monitor the fetal wellbeing. At the same time the mother’s creatinine clearance (kidney function) can be measured. If there is any deterioration, the baby may have to be delivered by Cesarean section on an emergency basis and the baby be looked after in a baby nursery for premature babies under the supervision of a neonatologist.
Without intervention there is a high risk for a stillborn baby in this setting and the mother could quickly progress from preeclampsia to eclampsia with an increasing mortality.
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