Dr Richa Sharma and Dr Amit Basnotra
Infertility is a stressful condition for the affect not only the couple but the whole family.A new baby is a bundle of joy for any family. But pregnancy can put a lot of stress on your body. Problem takes a bad shape when you have the underlying medical illness also.In this article we will discuss about the kidney disease and its after affects on fertility,fertility treatments and the pregnancy risks and vice versa.
What are the deciding factors?
It needs a multidisciplinary approach and there are various factors which can affect the decision as to whether the suffering lady can plan pregnancy or not.
* Stage of kidney disease , presence of protein in urine which is a sign of kidney damage!
* General health
* Add on health issues like- high blood pressure, diabetes, or heart disease
Renal disease can affect the outcome of pregnancy, pregnancy can affect the progression of pre-existing renal disease, and pregnancy can itself cause renal impairment. The renal system undergoes significant physiological and anatomical changes during a normal pregnancy
Possibilities of Carrying a baby –
Mild kidney disease-
There is good evidence to suggest that women with very mild kidney disease (stages 1-2), normal blood pressure, and little or no protein in the urine (called “proteinuria”) can have a healthy pregnancy.
What is proteinuria?
It’s a sign of kidney damage. Your body needs protein. But it should be in your blood, not your urine. Having protein in your urine usually means that your kidneys cannot filter your blood well and the protein is leaking out.
Moderate to severe kidney disease-
In women with moderate to severe kidney disease (stages 3-5), the risk of complications is much greater. For some women, the risk to mother and child is high enough that they should consider avoiding pregnancy.
Renal dialysis and Pregnancy chances –
Some changes in your body make it hard to become pregnant such as anemia (a low red blood cell count) and hormone changes may keep them from having regular menstrual periods.
Women with kidney failure are usually advised against becoming pregnant. The rate of complications is very high. Risks to both the mother and developing baby are high.
Renal Transplant and Pregnancy –
With kidney transplant with regular menstrual periods and good general health , getting pregnant and having a child is possible. But you should not become pregnant for at least one year after your transplant, even with stable kidney function. Some medicines that you take after a kidney transplant can cause problems to a developing baby. In some cases, pregnancy may not be recommended because there is a high risk to you or the baby. Another reason is if there is a risk of losing the transplant.
Pathophysiological Changes in a pregnancy with Renal Impairment-
Renal disease can affect the outcome of pregnancy, pregnancy can affect the progression of pre-existing renal disease, and pregnancy can itself cause renal impairment. The renal system undergoes significant physiological and anatomical changes during a normal pregnancy:
* Renal plasma flow increases by 50-70% in pregnancy (the change is most pronounced in the first two trimesters).
* There is an increased glomerular filtration rate (GFR), which peaks at about the 13th week of pregnancy and can reach levels up to 150% of normal.
* Therefore, both urea and creatinine levels are decreased.
* Increased levels of progesterone at the beginning of pregnancy increase relaxation of arterial smooth muscles and so decrease peripheral vascular resistance, causing a blood pressure fall of approximately 10 mm Hg in the first 24 weeks of pregnancy.
Pregnancy-induced renal disease-
Women found, or suspected to have, renal disease in pregnancy should be referred to a nephrologist.
* Pregnancy itself can cause acute kidney injury and renal disease can present for the first time during pregnancy.
* Acute kidney injury in pregnancy may be due to various causes, including:
* Septicaemia – eg, septic abortion, pyelonephritis.
* Haemolysis – eg, sickling crisis, malaria.
* Hypovolaemia – eg, pre-eclampsia, antepartum haemorrhage, intrapartum or postpartum haemorrhage, disseminated intravascular coagulation (DIC), abortion.
Problems related to specific kidney diseases in pregnancy
* Reflux nephropathy:
* Prophylactic antibiotics are required.
* Potential for inheritance.
* Systemic lupus erythematosus:
* High risk of spontaneous abortion.
* May need immunosuppressant therapy.
* Problems for the fetus (eg, neonatal lupus, heart block).
* Diabetic nephropathy:
* Deterioration of hypertension.
* Increased risk of pre-eclampsia.
* Accelerated decline in renal function.
* Kidney transplant recipient:
* Increased risk of miscarriage in the first trimester.
* Risk from some immunosuppressants (eg, mycophenolate mofetil).
* Increased risk of hypertension.
* Premature delivery.
( The authors are Senior IVF Consultant Mumbai and Senior Gastroentrologist Delhi)
Dr Richa Sharma and Dr Amit Basnotra