kidney in pregnancy

Overview

Kidney disease during pregnancy means that your kidneys, which filter waste and extra fluid from your blood, are not working as well as they should while you are expecting a baby. This can affect both your health and your baby's health, so it needs careful monitoring and care.

Kidney disease is not very common in pregnancy, but some kidney-related problems, such as pre-eclampsia (a serious blood pressure disorder), can affect a small number of pregnancies.

It can affect women who already have kidney disease before pregnancy, as well as women who develop kidney problems during pregnancy. Women with high blood pressure, diabetes, or a previous history of pre-eclampsia are more likely to have kidney issues.

Symptoms

Common symptoms

• Swelling in your feet, ankles, or hands
• High blood pressure
• Foamy or bloody urine
• Feeling very tired
• Needing to pass urine more often than usual

Symptoms in children

• If the mother has kidney disease, the baby may show signs of poor growth, low birth weight, or early birth.

Symptoms in older adults

• There are no separate symptoms for older mothers; the symptoms are the same. However, pregnant women over 35 are more likely to have high blood pressure and kidney problems.

Causes

Main causes

• Pre-existing kidney disease, such as chronic kidney disease or a kidney condition you were born with
• High blood pressure that begins or worsens during pregnancy
• Diabetes, especially if your blood sugar is not well controlled
• Kidney or urinary tract infections
• Pre-eclampsia, a condition that affects the kidneys and can be dangerous for both mother and baby

Risk factors

• Having had kidney disease or a kidney transplant before pregnancy
• Chronic high blood pressure or diabetes
• A previous pregnancy affected by pre-eclampsia
• Obesity
• Multiple pregnancy (twins, triplets, or more)
• Maternal age over 35

When to see a doctor

See a doctor urgently if:

• Call your local emergency number immediately if you have a seizure, you cannot breathe, or you have severe chest pain.
• Contact your maternity unit right away if you notice your baby moving less than usual, have heavy bleeding, or have severe pain in your belly or back.

Book a routine appointment if:

• If you are pregnant and have any risk factors for kidney disease, talk to your doctor as soon as you find out you are pregnant.
• If you notice swelling, high blood pressure readings, or changes in your urine, book an appointment with your midwife or doctor.

Diagnosis

Doctors check for kidney problems during pregnancy by reviewing your medical history, checking your blood pressure, and testing your blood and urine.

Tests that may be done

• Blood pressure checks
• Urine tests to check for protein or blood
• Blood tests to check kidney function (for example, creatinine levels)
• Ultrasound of your kidneys if needed
• Fetal ultrasound to check your baby's growth

What to expect at your appointment

Your doctor will explain what your test results mean. Depending on the results, you may be referred to a kidney specialist (nephrologist) and a high-risk pregnancy team. You will likely need more frequent check-ups to keep an eye on you and your baby.

Treatment

Treatment for kidney disease during pregnancy depends on the cause and how serious it is. The main goals are to protect your health, support your baby's growth, and prevent complications.

Self-care at home

• Take any prescribed medicines exactly as directed—never stop or change them without talking to your doctor.
• Monitor your blood pressure at home if your doctor advises it.
• Rest regularly and avoid strenuous activity if your doctor says so.
• Keep all your prenatal and specialist appointments.

Medical treatments

Your doctor may recommend medicines to lower blood pressure or to protect your kidneys. Some medicines are safe during pregnancy, while others are not. If pre-eclampsia develops, you might need close monitoring in hospital and treatment to prevent seizures. Do not take any over-the-counter medicines, supplements, or herbal remedies without checking with your healthcare team.

When is surgery considered?

Surgery is rarely needed for kidney problems during pregnancy. If you have a severe blockage in the urinary tract, you may need a small procedure to drain urine. Your doctor will discuss the risks and benefits with you.

Living with this condition

Living with kidney disease during pregnancy means paying close attention to your body. Follow your care plan, attend all appointments, and let your healthcare team know if anything changes.

Lifestyle tips

• Eat a balanced, low-salt diet if recommended by your doctor or dietitian.
• Stay well-hydrated unless you are told otherwise.
• Get enough rest and sleep.
• Quit smoking and avoid all alcohol and recreational drugs.

Diet and exercise

Your doctor or dietitian can give you specific advice about diet and physical activity. In general, a diet low in salt and processed foods is helpful. Gentle exercise like walking may be safe, but always ask your healthcare team before starting any new exercise routine.

Mental health and emotional wellbeing

Being told you have a health condition during pregnancy can be stressful and worrying. It is normal to feel anxious or overwhelmed. Talk to your midwife or doctor about how you feel, and ask for support if you need it. If you ever feel unsafe or have thoughts of harming yourself, contact your local mental health crisis service or emergency services immediately.

Prevention

Some kidney problems cannot be prevented, especially if you already have kidney disease before pregnancy. However, controlling blood pressure, managing diabetes, and starting prenatal care early can reduce the risk of complications.

Vaccines

Vaccines that are safe in pregnancy, such as the flu vaccine, can help protect against infections that might harm your kidneys or your baby. Your doctor will tell you which vaccines are recommended for you.

Screening programmes

Routine prenatal visits include blood pressure checks and urine tests, which can pick up early signs of kidney problems. If you have risk factors, your doctor may recommend additional screening tests.

Complications

If left untreated

• Untreated kidney disease in pregnancy can lead to pre-eclampsia, which is dangerous for both mother and baby.
• It can cause your baby to be born early or have a low birth weight.
• In rare cases, it can lead to long-term kidney damage or kidney failure.

Long-term outlook

With good medical care and close monitoring, many women with kidney disease go on to have a healthy pregnancy and baby. Your healthcare team will do everything they can to support you and your baby. If you have kidney disease and are thinking about pregnancy, talk to your doctor beforehand to make a plan.

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