Chronic renal disease in pregnancy: recognition and prognosis
THE CONTEXT
Chronic renal disease is reported in 0.2% of pregnancies. Urine microscopy and serum biochemical findings can suggest the diagnosis, while prognosis varies with renal impairment.
Suggestive findings
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Urine microscopy may show more than 1–2 red blood cells per high-power field or red blood cell casts.
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An increased number of white blood cells or casts is another suggestive urinary finding.
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Serum uric acid and creatinine levels may be raised.
Importance of baseline renal function
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Mildly compromised renal function is generally not associated with adverse maternal or fetal outcomes.
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With mild impairment, the reported risk of long-term renal deterioration leading to end-stage renal failure or a need for dialysis is low, at 5%.
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Moderately or severely compromised renal function is associated with adverse pregnancy outcomes in 50% as renal function deteriorates.