How does kidney disease affect pregnancy?

The article is professionally consulted by Master, Doctor Ly Thi Thanh Nha - Department of Obstetrics and Gynecology - Vinmec International General Hospital Da Nang.

Women who already have kidney disease need to be carefully considered before becoming pregnant because kidney disease during pregnancy can progress more seriously and cause many dangerous complications during pregnancy.

Kidney size increases during pregnancy: the length of the kidney increases by about 1cm compared to pre-pregnancy. The size of the kidneys will return to normal after birth; Dilatation of the renal pelvis and ureters: due to fluid retention due to urinary obstruction. This fluid retention is usually mild and is referred to as “physiological” pyelonephritis in pregnancy. Urine stagnation favors urinary tract infections and can progress to severe pyelonephritis; Renal blood flow and glomerular filtration rate in pregnant women are increased by approximately 40% of normal. These flows increase quite early, as early as the first months of pregnancy. This increase in glomerular filtration rate increases the excretion of waste products. Serum creatinine levels decrease by about 35 to 44% of the normal value. Decrease blood albumin concentration, decrease blood urea and decrease plasma osmolality; The amount of water increases about 6-9 liters, of which mainly water is in the extracellular compartment, about 4-6 liters. During pregnancy the plasma volume almost doubles and edema is normal.

Patients with pre-existing kidney disease should be considered before becoming pregnant because the disease can cause many dangerous complications during pregnancy. During pregnancy, the disease will get worse and increase the risk of toxicity, infection, pre-eclampsia, hypertension, miscarriage, premature birth... Specifically, the impact of each type of kidney disease on Pregnancy is as follows:
Primary nephrotic syndrome: If the patient is completely cured over 6 months and the kidney function returns to normal or only grade I renal failure, a normal pregnancy is still possible. In case the disease progression is not satisfactory and the patient has kidney failure grade II or higher, pregnancy should not be performed; Chronic kidney failure: Pregnancy will greatly affect the course of the disease and pregnant women may experience dangerous complications. In chronic kidney failure, many experts recommend that you can get pregnant while CKD is still in stages I, II. But it must be monitored and treated very closely. When the patient has end-stage renal failure, pregnancy should not be; Acute glomerulonephritis : the patient can still have a normal pregnancy, but it is necessary to closely monitor and pay attention to controlling weight, blood pressure and proteinuria. For women with pre-existing kidney disease, the disease will greatly affect the health of the mother and the fetus. Therefore, it is necessary to consider carefully when trying to become pregnant and to consult a specialist for advice.

The amount of water taken into the body depends on the level of excretion by the kidneys (depending on the progression of the disease), usually from 1.5-2 liters per day (including filtered water, milk, broth, soup, from fruits) tree...); Pregnant women with kidney disease should eat as light as possible, reduce spices when seasoning; Protein-rich foods such as lean meat, fish, shrimp, eggs, milk, tofu... should be eaten in moderation according to the doctor's advice; Sea fish should be boiled and then removed from the water to reduce salt; Should eat a variety of vegetables and fruits and do not drink a lot of vegetable broth; Limit eating foods with a lot of salt such as pickles, salted eggplant, fish sauce, dried fish, sausages, bacon, canned goods, spring rolls, ....

Pregnant women with kidney disease need to be carefully checked for pregnancy health, to prevent dangerous complications that kidney disease can cause to the fetus. Pregnant women can refer to the Maternity Care Program at Vinmec International General Hospital with full maternity care services depending on the stages of pregnancy. When participating in these packages, pregnant women will be closely monitored all developments during pregnancy, perform all necessary screening tests to detect early signs of abnormalities of the mother and fetus and best intervention.
Master. Doctor. Ly Thi Thanh Nha has worked at Hue University of Medicine and Pharmacy Hospital and Quang Tri Provincial General Hospital before working at Vinmec Danang International Hospital as it is now.
Doctor Nha has strengths and experience in diagnosing, monitoring and treating pregnancy, pregnancy pathology. Pregnancy screening. Perform caesarean section techniques. Laparoscopic surgery to treat ovarian cysts, ectopic pregnancy.