A review of the implications of chronic kidney disease in pregnancy on maternal and fetal outcomes

Abstract

The prevalence of pregnancies complicated by chronic kidney disease (CKD) is increasing. Yet, CKD in pregnancy tends to be under-diagnosed, as women of childbearing age are not regularly screened for renal dysfunction, nor is screening incorporated into routine pregnancy follow up. Further, renal dysfunction has significant implications for maternal and fetal outcomes, with degree of renal dysfunction at conception being the most important prognostic factor. It is established that the risk for poorer renal, maternal and fetal outcomes, increases incrementally with severity of CKD, with intrauterine death and progression to end-stage renal disease (ESDR) associated with severe CKD. However, it is difficult to predict which CKD pregnancies will lead to poor outcomes as the definition of CKD in pregnancy is not uniform between studies, nor are measurement parameters. This paucity of data prevents the establishment of a standard of care protocol and leaves clinicians ill-equipped to care for and manage this complex patient cohort. This review discusses renal, maternal and fetal outcomes in CKD pregnancies as presented by the literature, in order to demonstrate the contradictions in data and gaps in knowledge surrounding this topic, as well as the need for a general management algorithm.