Kidney disease developing during pregnancy in previously healthy women
Urine infections are common during pregnancy. One of the reasons for this is that the baby lies above the bladder, and can reduce the flow of urine from the kidneys to the bladder. A urine infection usually causes pain when passing urine, and a need to go more often. The urine may be cloudy or smelly. In more severe infections, there may be a temperature and pain in the upper back, over the kidney.
A urine infection should be treated by increasing the amount of fluid a woman is drinking and by a course of antibiotic. There are several antibiotics that have been used extensively in pregnant women, and do not cause any side effects in the baby.
If urine infections occur repeatedly in pregnancy, it may be necessary to get a scan of the kidneys, using an ultrasound (sound wave) scanner – this is the same machine used to scan the baby. The scan would be performed to make sure there are not kidney stones or kidneys affected by disease early in childhood. A scan would be expected to show back pressure on the kidneys during pregnancy (the medical term is hydronephrosis), this goes back to normal after pregnancy.
Rarely, a woman needs to take daily low dose antibiotics during pregnancy.
Minor kidney disease
Minor kidney diseases are common and a woman may have a condition for years without knowing about it. Because of checks performed during pregnancy, this condition may come to light for the first time. Extra blood tests and a kidney scan will be performed, and often a kidney specialist will be asked to give an opinion. However, if the kidney disease is minor, it usually does not affect the pregnancy. In some cases there could be a higher risk of high blood pressure near the end of pregnancy.
Kidney disease developing during pregnancy
Occasionally a new kidney disease develops during pregnancy. This is rare. Lupus may develop for the first time during, or just after, a pregnancy.
Women who are pregnant all have regular urine tests for protein, and regular measurement of their blood pressure. The reason for this is to detect any signs of a condition known as eclampsia. The early stages are called pre-eclampsia.
In pre-eclampsia there is protein in the urine and high blood pressure. There may be some headaches, but often a woman feels very well. This usually occurs near the end of pregnancy. Treatment for pre-eclampsia is important to prevent progression to eclampsia, where there is very high blood pressure with kidney failure and fits (convulsions).
A woman with pre-eclampsia is usually advised to rest and to take drugs to reduce the blood pressure. There are a number of drugs to reduce the blood pressure that have been shown to be safe for the baby. Intensive out-patient monitoring, or sometimes admission to hospital, are required. Nearly everyone with pre-eclampsia responds to treatment. If treatment is not working, it may be best to deliver the baby prematurely, because pre-eclampsia goes away when the woman is no longer pregnant.
Kidney failure from eclampsia is very rare, occurring at a rate of less than 1 in 5000 pregnancies in the United Kingdom. When it does occur, delivery of the baby is imperative, and Caesarian section may be performed. Dialysis (artificial kidney) treatment may be necessary if the kidney failure is complete. Kidney function usually returns after a few days or two to three weeks. Very, very rarely the kidneys may be so damaged that they do not recover function, and the woman needs long term dialysis or a kidney transplant.
A woman who has had pre-eclampsia or eclampsia is at increased risk of developing it again during another pregnancy. The possible risks of pregnancy should be discussed with doctors. Many women who have had pre-eclampsia have further pregnancies without problems, but careful monitoring throughout pregnancy is essential.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.