Pregnancy often does not worsen renal disorders; it seems to exacerbate noninfectious renal disorders only when uncontrolled hypertension coexists. However, significant renal insufficiency (serum creatinine > 3 mg/dL [> 270 μmol/L] or BUN > 30 mg/dL [> 10.5 mmol urea/L]) before pregnancy usually prevents women from maintaining a pregnancy to term.

Maternal renal insufficiency may cause

After kidney transplantation, full-term, uncomplicated pregnancy is often possible if women have all of the following:

Treatment of renal insufficiency during pregnancy requires close consultation with a nephrologist. BP and weight are measured every 2 wk; BUN and creatinine levels plus creatinine clearance are measured often, at intervals dictated by severity and progression of disease. Furosemide is given only as needed to control BP or excessive edema; some women require other drugs to control BP. Women with severe renal insufficiency may require hospitalization after 28 wk gestation for bed rest, BP control, and close fetal monitoring. If results of antenatal testing remain normal and reassuring, the pregnancy continues.

Delivery is usually required before term because preeclampsia, fetal growth restriction, or uteroplacental insufficiency develop. Sometimes amniocentesis to check fetal lung maturity can help determine when delivery should be done; a lecithin/sphingomyelin ratio of > 2:1 or presence of phosphatidylglycerol indicates maturity. Cesarean delivery is very common, although vaginal delivery may be possible if the cervix is ripe and no impediments to vaginal delivery are evident.