Anatomic Changes in the Kidney During Pregnancy

Kidney disease and hypertensive disorders in pregnancy are discussed. Pregnancy in women with kidney disease is associated with significant complications when renal function is impaired and hypertension predates pregnancy. When renal function is well preserved and hypertension absent, the outlook for both mother and fetus is excellent. The basis for the close interrelationship between reproductive function and renal function is intriguing and suggests that intact renal function is necessary for the physiologic adjustments to pregnancy, such as vasodilation, lower blood pressure, increased plasma volume, and increased cardiac output. The renal physiologic adjustments to pregnancy are reviewed, including hemodynamic and metabolic alterations. The common primary and secondary renal diseases that may occur in pregnant women also are discussed. Some considerations for the management of end-stage renal disease in pregnancy are given. Hypertensive disorders in pregnancy are far more common than is renal disease. Almost 10% of all pregnancies are complicated by either preeclampsia, chronic hypertension, or transient hypertension. Preeclampsia is of particular interest because it is associated with life-threatening manifestations, including seizures (eclampsia), renal failure, coagulopathy, and rarely, stroke. Significant progress has been made in our understanding of some of the pathophysiologic manifestations of preeclampsia; however, the cause of this disease remains unknown. The diagnostic categories of hypertension in pregnancy, pathophysiology of preeclampsia, and important principles of prevention and treatment also are reviewed. Phyllis August