Stage 1: eGFR >=90 with other evidence of renal disease (e.g., proteinuria)
Stage 2: eGFR 60-89
Stage 3a: eGFR 45-59
Stage 3b: eGFR 30-44
Stage 4: eGFR 15-29
Stage 5: eGFR <15
CKD stage:
Pre-pregnancy eGFR:
Proteinuria:
Baseline bloods: (FBC, haematinics, U&Es, LFTs, calcium, phosphate, bicarbonate)
Stop/rationalise medications: (methotrexate, cyclophasmide, mycophenolate, ARBs)
Delay pregnancy:
>1 year (renal transplant, glomerulonephritis)
>6 months (lupus nephritis/vasculitis once quiescent)
After transplant (dialysis)
Contraception:
Blood pressure:
Glycaemic control/HbA1c:
Pregnancy risks: infertility, miscarriage and fetal loss, preterm birth & neonatal care, FGR, Caesarean section
Serial renal function (FBC, haematinics, U&Es, LFTs, calcium, phosphate, bicarbonate, vitamin D) and proteinuria testing
Serial weights, fluid balance
Bicarbonate replacement (aim >16)
Anaemia:
Consider Ferinject
Consider EPO (Hb <100, ferritin >100)
Hypertension:
Aspirin 150 mg OD
Enhanced monitoring (aim <130/80)
VTE:
PCR >300: LMWH
<300: treat as one risk factor
Diabetes:
OGTT if taking tacrolimus/cyclosporin
Fetal:
Test for anti-Ro/La (lupus)
Serial growth scans (consider from 24 weeks)
Stage 1-2:
Renal deterioration: reversible (8%), progressive (3%)
PET: 10-20%
SGA: 25%
Preterm birth <34 weeks: 10%
Stage 3-5:
Live birth rate (after 12 weeks): 98%
Preterm birth <34 weeks: 26% (usually driven by hypertension)
SGA <10th: 36%
Severe SGA <3rd: 22%
Significant worsening (>25%) or needing dialysis: 46%
Postpartum eGFR change equivalent to 2.5 years progression (or 4.5 years with a transplant) which is greater in women with hypertension
Clinical guideline for renal disease in pregnancy (Wiles, et al. 2019) https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-019-1560-2
Pregnancy outcomes with CKD 3-5 (Wiles, et al. 2021) https://academic.oup.com/ndt/article/36/11/2008/6032223