Core Curriculum
Renal Disorders in Pregnancy: Core Curriculum 2019

https://doi.org/10.1053/j.ajkd.2018.06.006Get rights and content

As the incidence of chronic kidney disease increases and women pursue pregnancy at more advanced ages, the management of kidney disease in pregnancy has become increasingly relevant to the practicing nephrologist. Women with kidney disorders face several challenges in pregnancy due to increased physiologic demands on the kidney and risk for disease progression, the potential teratogenicity of medications, and the increased risk for complications such as preeclampsia and preterm delivery. Challenges posed by an underlying disease process in pregnancy, such as autoimmune disease or diabetes mellitus, necessitate an interdisciplinary team to ensure good maternal and fetal outcomes. Rates of acute kidney injury in pregnancy are generally declining worldwide, but remain a significant public health concern in developing countries. Pregnancy may also be the first time that a woman has kidney disease or hypertension diagnosed. An understanding of what constitutes normal physiologic changes in pregnancy is critical in a diagnostic evaluation. In this review, we review physiologic changes in pregnancy, causes and management of acute kidney injury in pregnancy, hypertensive disorders of pregnancy, and how to care for women with chronic kidney disease of various causes, including the use of antihypertensives and immunosuppressants.

Index Words

Pregnancy
renal disease
preeclampsia
renal outcomes
maternal fetal complications
acute kidney injury (AKI)
chronic kidney disease (CKD)
autoimmune disease
diabetes mellitus
hypertension
immunosuppression
dialysis
kidney transplantation
review

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Complete author and article information provided at end of article.

Authors’ Full Names and Academic Degrees: Maria L. Gonzalez Suarez, MD, PhD, Andrea Kattah, MD, Joseph P. Grande, MD, PhD, and Vesna Garovic, MD, PhD.

Support: Dr Garovic is supported by award number P50AG44170 from the National Institute on Aging.

Financial Disclosure: The authors declare that they have no relevant financial interests.

Peer Review: Received February 15, 2018, in response to an invitation from the journal. Evaluated by 2 external peer reviewers and a member of the Feature Advisory Board, with direct editorial input from the Feature Editor and a Deputy Editor. Accepted in revised form June 1, 2018.

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