nephritis in pregnancy

Overview

Nephritis means inflammation (swelling) of the kidneys. The kidneys are two bean-shaped organs that filter waste from your blood and make urine. When they become inflamed, they may not work as well as they should. In pregnancy, this can happen because a urine infection has spread up to the kidneys (often called a kidney infection), or because a kidney condition you already had, like lupus nephritis, flares up. It needs careful medical care to keep both you and your baby safe.

Kidney infections (a common type of nephritis) happen in about 1 in 30 pregnancies. Other types of nephritis linked to immune system conditions are less common, but they can occur in women who already have kidney problems.

It can affect any pregnant woman. You are more at risk if you have had a kidney infection before, have kidney stones, diabetes, high blood pressure, or an immune system condition like lupus.

Symptoms

Common symptoms

• High fever (often over 100.4°F / 38°C)
• Pain in the lower back, side, or groin
• Pain or burning when passing urine
• Feeling tired, achy, or generally unwell
• Needing to urinate more often than usual
• Cloudy, dark, or bloody urine

Causes

Main causes

• Bacterial infection: A urine infection can travel from the bladder up to the kidneys, causing inflammation.
• Autoimmune conditions: Diseases like lupus or IgA nephropathy make your immune system attack your own kidneys.
• Pre-existing kidney disease: A long-term kidney inflammation may become worse during pregnancy.

Risk factors

• Having had a kidney infection in the past
• Having kidney stones or a condition called vesicoureteral reflux, where urine flows backward toward the kidneys
• Having diabetes, high blood pressure, or an autoimmune disease
• Being pregnant — the growing uterus can press on the tubes that carry urine, slowing the flow and making infection more likely

When to see a doctor

See a doctor urgently if:

• If you have a fever, back pain, or burning when you pass urine
• If you see blood in your urine
• If you feel generally unwell with chills or aches
• If you have reduced baby movements after 28 weeks

Book a routine appointment if:

• At every prenatal appointment, mention any new symptoms, even if they seem mild.
• If you have chronic kidney disease or lupus, see a kidney specialist regularly to check your kidney function and blood pressure.

Diagnosis

Your doctor will ask about your symptoms, check your temperature, and gently press on your back to check for pain. They will test your urine and may do blood tests. Sometimes they will use an ultrasound to look at your kidneys and check that urine is flowing normally.

Tests that may be done

• Urine test: to check for infection, blood, or protein
• Blood tests: to check how well your kidneys are working and to look for signs of infection
• Kidney ultrasound: a safe imaging test that uses sound waves to create pictures of your kidneys and bladder
• Blood pressure check and urine protein test: to monitor for preeclampsia, a serious condition sometimes linked to nephritis

What to expect at your appointment

You may have to give a urine sample and have blood taken. This can be done at your doctor’s office or at a hospital. The tests are safe for you and your baby. If an infection is found, you may be given antibiotics to take at home, or you may need to stay in hospital for a short time to receive fluids and antibiotics through a drip. The medical team will explain each step and answer your questions.

Treatment

Treatment depends on the cause. If bacteria are causing the nephritis, you will be given antibiotics that are safe to take during pregnancy. If the cause is an autoimmune condition, a specialist may prescribe medicines to calm the immune system. Never take any medicines, including painkillers or natural remedies, without checking with your doctor first — some can harm your baby.

Self-care at home

• Drink plenty of fluids, unless your doctor tells you to limit them
• Rest as much as you can and let others help you
• Take your temperature regularly and watch for new symptoms
• Go to all follow-up appointments, even if you start to feel better
• Finish any treatment your doctor gives you, exactly as directed

Medical treatments

Doctors may prescribe antibiotics that are safe in pregnancy for a kidney infection. For autoimmune-related nephritis, specialists may use medications that reduce inflammation or calm the immune system. If the condition is severe, you may be admitted to hospital for observation and supportive care, such as fluids through a drip. Your doctor will choose the safest approach for you and your baby.

When is surgery considered?

Surgery is rarely needed for nephritis during pregnancy. If a kidney stone is blocking the flow of urine, a small tube called a stent may be placed by a specialist to keep the urine draining. This is not common and only done when necessary.

Living with this condition

You may feel very tired while recovering, so plan for extra rest and ask for help with daily tasks. Keep all your prenatal appointments so your doctor can monitor both your kidneys and your baby. If you are seeing a kidney specialist, they will work together with your maternity team to provide the best care.

Lifestyle tips

• Attend every prenatal check-up, even if you feel fine
• Drink enough fluids unless you have been told to restrict them
• Report any fever, chills, or pain to your doctor immediately
• Avoid alcohol and tobacco
• Take your medicines only as prescribed — do not stop without talking to your doctor

Diet and exercise

Eat a balanced diet with fruits, vegetables, whole grains, and lean proteins. Your doctor may suggest reducing salt if you have high blood pressure or swelling. Light activity like walking is usually fine, but always check with your doctor. If you have protein in your urine or high blood pressure, they may recommend more rest and less strenuous activity.

Mental health and emotional wellbeing

Having a health problem during pregnancy can be worrying and stressful. It is completely normal to feel anxious or overwhelmed. Talk to your partner, family, or a close friend. If you feel very low, hopeless, or have thoughts of harming yourself, speak to your midwife or doctor — they can connect you with counselling and mental health support.

Prevention

Not all cases can be prevented, but you can lower your risk by staying well hydrated, passing urine regularly, and treating urine infections early. If you have kidney disease or an autoimmune condition, talk to your specialist before becoming pregnant to plan the safest approach.

Vaccines

Make sure your routine vaccinations are up to date before pregnancy. Your doctor may recommend safe vaccines during pregnancy, such as the flu or whooping cough vaccine. Ask your doctor or nurse which ones are right for you.

Screening programmes

If you are at higher risk for kidney problems, your doctor may check your urine and blood pressure at every prenatal visit. This helps detect nephritis early, before it becomes severe.

Complications

If left untreated

• The infection can spread to your bloodstream, causing sepsis — a severe and life-threatening reaction
• Permanent kidney damage
• Preterm labour (giving birth too early)
• Low birth weight for your baby
• Preeclampsia — a dangerous condition with high blood pressure and protein in the urine

Long-term outlook

With early diagnosis and proper treatment, most women with nephritis in pregnancy recover fully and go on to deliver healthy babies. If you have a long-term kidney condition, specialists will work closely with you throughout your pregnancy to keep it under control. There are extra safety checks and more appointments, but many women with such conditions have safe and successful pregnancies. The key is to get the right care early and follow your medical team’s advice.

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