Primary care for kidney disease in pregnant women

A Narrative Review.

Abstract

Introduction: Healthy women may show various renal disorders during pregnancy, from mild acute forms without consequences to severe forms, which compromise the completion of pregnancy and cause severe consequences for the pregnant woman and fetus.

Objective of the review: To provide an update from the point of view of primary care, on managing pregnant patients with renal diseases.

Essential points of the review:

Pregnancy induces adaptive physiological changes in the renal system, essential for ensuring maternal-fetal health. The increase in renal size and glomerular filtration leads to increased urate excretion.

Pregnancy activates the renin-angiotensin-aldosterone system and decreases plasma osmolarity due to water retention and reduced sodium concentration. Consequently, the increase in compensatory sodium reabsorption increases.

In women with chronic kidney disease (CKD), these adaptations may be compromised, increasing the risk of complications such as preeclampsia, preterm birth, and low birth weight. The risk depends on the degree of kidney function loss before pregnancy.

Pregnancy-related acute kidney disease is less common in developed countries but remains a significant cause of maternal mortality and morbidity.

Conclusions: Adequate prenatal care is essential for women with chronic kidney disease or acute kidney disease during pregnancy. This includes close monitoring of blood pressure, kidney function, and fetal well-being.