Pregnancy results in important alterations in acid-base, electrolyte, and renal function due to pregnancy-associated physiologic changes in renal and systemic hemodynamics that occur.
Understanding these changes is essential when evaluating kidney disease pregnancy . Disorders that cause acute kidney or renal failure in early or late pregnancy generally fall into very different categories, and it must also be remembered that pregnancies in women with underlying chronic kidney disease and dialysis who require dialysis during pregnancy, or who have previously undergone renal transplantation pose unique sets of issues. Understanding the physiologic changes and disorders that occur in women with renal disease in pregnancy forms the basis of appropriate management of these unusual disorders.
Chronic kidney disease (CKD) carries significant risks to the mother and fetus in pregnancy.
During a normal pregnancy the renal function undergoes physiological and anatomic changes.
Physiological changes:
The renal plasma flow rate escalates 50-70% during pregnancy (heavy load for kidneys), this change may be more visible during the first 2 trimester. This results in an increased glomerular filtration rate (GFR), that is, 150% of normal. This will be reducing the levels of both blood urea nitrogen (BUN) and creatinine. These changes may lead to renal disease during pregnancy.
Anatomic changes:
During the conception period the female body will show some anatomic changes. The size of the kidney will be increasing by about 1-1.5 cm. A dilatation of the uterus and pelvis occurs and is presumed to be secondary to the smooth muscle–relaxing effect of progesterone. This dilatation is often more pronounced on the right side secondary to dextrorotation of the uterus and dilatation of the right ovarian venous plexus, which in turn can lead to urinary stasis and, as discussed later, an increased risk of developing urinary tract infections (UTIs).
The renal plasma flow rate escalates 50-70% during pregnancy (heavy load for kidneys), this change may be more visible during the first 2 trimester. This results in an increased glomerular filtration rate (GFR), that is, 150% of normal. This will be reducing the levels of both blood urea nitrogen (BUN) and creatinine. These changes may lead to renal disease during pregnancy.
Anatomic changes:
During the conception period the female body will show some anatomic changes. The size of the kidney will be increasing by about 1-1.5 cm. A dilatation of the uterus and pelvis occurs and is presumed to be secondary to the smooth muscle–relaxing effect of progesterone. This dilatation is often more pronounced on the right side secondary to dextrorotation of the uterus and dilatation of the right ovarian venous plexus, which in turn can lead to urinary stasis and, as discussed later, an increased risk of developing urinary tract infections (UTIs).
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