What is kidney failure during pregnancy?
Kidney failure, also known as end-stage renal disease (ESRD), is a situation in which your kidneys are not functioning well enough to keep you alive without kidney dialysis or kidney transplantation. Kidney failure is the final stage (called stage 5) of what doctors call chronic kidney disease (CKD). As with most serious medical conditions, CKD affects pregnancy because it harms the body, and pregnancy affects CKD by putting increased demands on internal organs as pregnancy advances. Furthermore, CKD interferes with the ability to get pregnant in the first place. Whether or not you are pregnant, kidney failure also can occur as an acute condition, a condition that comes on suddenly, due to sudden damage to the kidneys, a reduction of blood flow to the kidneys, or blockage of the drainage system of urine. With CKD, there is a spectrum of severity; the worse the CKD, the harder it is to get pregnant, and the worse the effects on pregnancy if you do get pregnant. If you have ESRD, the chances of having a successful pregnancy are very low, but there have been cases of women delivering babies while on dialysis, or subsequent to receiving a kidney transplant.
How common is kidney failure during pregnancy?
The prevalence of CKD in pregnancy varies depending on the stage, with kidney failure (ESRD, the worst stage) being much less common than milder stages. Stages 1 and 2, in which kidney function is normal to mildly impaired, have been reported in as many as 3 percent of women of reproductive age, many of which get pregnant and have successful pregnancies. More advanced stages of CKD, including ESRD, affect 1 per every 150 women of reproductive age, but fertility is very low, and, for those who do get pregnant, the rate of spontaneous abortion (miscarriage) is high, so there are very few pregnancies reaching the point of carrying a baby that can survive.
How is kidney failure during pregnancy diagnosed?
Kidney disease, including kidney failure, is diagnosed with a range of laboratory tests on your urine and blood, imaging tests such as ultrasonography, and often biopsy in which a sample of the kidney is removed for analysis. In some cases, imaging may also include computerized tomography (CT) scanning, although doctors try to avoid this during pregnancy. CKD is classified into six stages, ranging from mild disease to kidney failure: 1, 2, 3A, 3B, 4, and 5. The stage is determined by your glomerular filtration rate (GFR). This is calculated based on the concentration of creatinine in your blood and other factors, such as your age, race, and various body measurements: the lower the GFR, the more advanced the stage of CKD. However, the severity of the disease and its impact on pregnancy and fertility also depends on other factors, such as the amount of protein in your urine, and the degree to which kidney disease affects your electrolytes and acid-base balance.
Does kidney failure cause problems during pregnancy?
Pregnancy is very rare in women ESRD, but the chances and severity of problems during pregnancy increase with the severity of CKD, and pregnancy can push your CKD to a more severe stage, in some cases leading to kidney failure. CKD also increases the chances that youll develop preeclampsia, a pregnancy complication featuring high blood pressure and dysfunction of at least one internal organ, usually the kidney. Kidney failure (ESRD) produces a range of problems throughout the body through processes that include the accumulation of toxins and the impairment of excretion of acid and potassium, leading to whats called metabolic acidosis (too much acid in body tissues) and hyperkalemia (potassium levels above normal). Kidney disease and failure also can produce a range of other conditions, such as anemia, high blood pressure, high cholesterol, swelling throughout the body, and decreased bone density, leading to fractures. All of this puts your life in danger, and to survive, you must go on kidney dialysis unless, or until, you can receive a kidney transplant. Although successful pregnancy is unusual in women with ESRD, some evidence suggests that getting more dialysis reduces the amount and severity of problems.
Does kidney failure cause problems for the baby?
Kidney disease elevates the risk that you will suffer from preeclampsia, which means that the baby will have to be delivered a few weeks early. With or without preeclampsia, CKD elevates the risk of fetal growth restriction, preterm delivery, low birth weight, and spontaneous abortion (miscarriage). In fact, for pregnant women on dialysis, the incidence of spontaneous abortion has been reported at close to 50 percent.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the kidney failure
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat kidney failure during pregnancy?
Medications are given for complications of kidney disease and failure. In some cases, such as with high blood pressure, certain medications are considered safe in pregnancy, while other medications, such as ACE inhibitors, must be stopped because they can harm the fetus. A type of medication, called a diuretic, may be given for lowering blood pressure, but also for reducing swelling and, if you have hyperkalemia, for improving the excretion of potassium. Supplemental calcium and vitamin D are important for all pregnant women, but with CKD, your needs are greater. As for anemia, the connection with kidney disease is that the kidneys normally produce a hormone called erythropoietin (EPO), which stimulates the production of new red blood cells (RBCs). Treatment for anemia may include EPO and also iron. As for high cholesterol, this is treated commonly with a group of drugs called statins. There is concern about statins causing birth defects to the point that these drugs should be avoided or stopped during pregnancy, but if you are taking them before knowing that you are pregnant, you should not worry about any harm; the drug should be stopped at that point. If you receive a kidney transplant, you will need other medications, but getting a transplant during pregnancy is not an option.
Who should NOT stop taking medication for kidney failure during pregnancy?
Management of the various complications of kidney disease and failure is very complex, especially during pregnancy. If you are taking medication, it is part of a delicate balance of benefits and risks, aimed at keeping you alive and minimizing harm to the baby, so medication should not be stopped unless this is done as a plan worked out with the medical specialists who are treating you.
What should I know about choosing a medication for my kidney failure during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my kidney failure when I am breastfeeding?
As during pregnancy, the purpose of medications after you have delivered is to confront complications of kidney disease and failure. Certain drug categories that must be stopped or replaced during pregnancy may be restarted if needed after delivery in nursing mothers. The ACE inhibitors captopril and enalapril, for instance, are thought to be safe in nursing, although drug levels should be monitored. With nutritional treatments, such as vitamin D and calcium, it is particularly important to continue the therapy if you are nursing since you need these agents, not only to keep your own bones strong but to produce good milk. In some cases, such as with statins, the concern is high enough that, generally, they should be avoided in nursing mothers, just as they are avoided during pregnancy. Certain treatments that you may be taking may actually provide benefits if they get into breastmilk. EPO in breastmilk, for instance, has been found to reduce the transmission of HIV (the virus that causes AIDS) from mothers to nursing infants.
What alternative therapies besides medications can I use to treat my kidney failure during pregnancy?
The main treatment for kidney failure is kidney dialysis, also called hemodialysis, although hemodialysis is one type of dialysis designed to mimic the function of kidneys. In hemodialysis, your blood vessel system is connected to a machine that filters and cleans the blood the way that the kidneys do. This is a big machine that cannot be implanted inside the body, and typically people on dialysis go to a dialysis center three times per week for a few hours. Dialysis machines have become smaller and cheaper over the years, so it is also possible to have a machine at home and receive dialysis more than three times per week, and for shorter sessions. More dialysis increased dialysis dose may improve pregnancy outcomes for mothers and babies. Efforts are underway to miniaturize dialysis to the point of producing artificial kidneys. Until that happens, definitive treatment for kidney failure is possible only with transplantation of a kidney. Such kidneys can come either from donors who have died or from a live donor since a person can live with one kidney.
What can I do for myself and my baby when I have kidney failure during pregnancy?
Follow the instructions of your physician. If you are not pregnant and have ESRD or high stage renal disease, you should discuss with your doctors the issue of whether you should even try to get pregnant. If you have kidney failure, it is vital to go to all of your needed dialysis sessions.
Resources for kidney failure in pregnancy:
For more information about kidney failure during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: