1. I have kidney disease, can I get pregnant? Of course
can!
However, kidney friends with different conditions have very different risks of pregnancy. Before intends to become pregnant, you must find a reliable nephrologist for follow-up in advance.
2. When is the kidney friend pregnant?
If you are planning to have a baby, you need to get pregnant as soon as possible.
The right time for ordinary people to become pregnant is before the age of 35. Those over 35 years old are called " advanced parturients ". As they grow older, they regenerate, gestational hypertension, diabetes, preeclampsia... The incidence of various adverse conditions has increased significantly, and complications such as hypertension and hyperglycemia will increase. Risk of worsening kidney disease.
And, as the age grows, some patients with kidney disease may lose the chance of pregnancy because of the prolonged kidney disease and the progress of the disease.
3. What should I prepare before pregnancy? In addition to the general requirements of ordinary people: quit smoking and alcohol, have a good mentality, get enough sleep, and have a balanced diet.
and start taking folic acid 3 months before pregnancy to prevent fetal neural tube malformations, these necessary preparations. The two most important points for the
nephrologists are: nephropathy is relatively stable; all medicines that cannot be used during pregnancy should be stopped.
4. Does pregnancy cause kidney disease to worsen?
For any woman, pregnancy cannot guarantee 100% safety.
Therefore, even if your kidney disease is mild and stable, the doctor will not guarantee you 100% that the kidney disease will not progress.
In general, kidney friends who meet the following conditions have a lower risk of pregnancy.
5. What conditions are met and the risk of pregnancy is low?
and at the same time, the nephrologist who meets the following conditions:
1) has good renal function and normal blood creatinine (or close to normal). Patients whose renal function is in CKD1-2 stage, that is, the glomerular filtration rate is greater than 60. This one is the most important!
2) Nephropathy is relatively stable, urine protein is controlled within 1-2g, blood pressure is normal
3) Not in the active phase of systemic diseases, such as active lupus
4) Some drugs that cause fetal malformations have been stopped
5) Regularly in the nephrology Follow up by the doctor
6. Why do you say that kidney function is the most important?
Because the patient's renal function is good, it is the key to determine whether the kidney disease will worsen after pregnancy!
A meta-analysis conducted by the team of Professor Lv Jicheng and Zhang Hong from Peking University First Hospital, compared 1268 patients with better renal function (CKD 1~2) who are pregnant, and the data of non-pregnant kidney friends. It was found that pregnancy did not increase the distance of women. Risk of progression of renal disease (double creatinine, uremia).
7. High blood creatinine, renal insufficiency, high risk of pregnancy?
is big!
has just said that kidney function is one of the biggest factors affecting pregnancy of nephrologists. Once
enters the stage of renal insufficiency, the risk of pregnancy for patients with CKD3-5 stage increases sharply .
8. There is a high risk of pregnancy. What are the risks?
about mother : deterioration of renal function, hypertension, obstetric-related complications such as preeclampsia, placental abruption, etc.
about baby : fetal growth retardation, premature fetal delivery, etc.
9. Pregnancy in patients with renal insufficiency will definitely occur Is the above situation?
first look at a set of data. A classic data about pregnancy in patients with renal insufficiency, published in the journal NEJM.
This study analyzed the pregnancy data of 62 women with renal insufficiency. Their blood creatinine was at least 124umol/l (an average of about 168). After pregnancy, 43% of women (23 people) experienced irreversible deterioration in renal function. Seven of them entered uremia because of pregnancy within 1 year after delivery. The premature birth rate of
fetus is 59%. However, a little relief is that the overall survival rate of the fetus is higher, at 93%.
10. So, people with renal insufficiency have no chance of getting pregnant?
no one can take awayYour right to have children.
Some people think: I am not willing to take such a big risk of deterioration of renal function for the sake of a child!
and some people think: children are very, very important to me, I am willing to use the time of entering uremia a few years in advance to change the birth of a child, I want to give it a try!
Everyone has different ideas. Find a doctor who you think is reliable, and communicate with the doctor sincerely.
11. What will happen to pregnancy if proteinuria is not controlled?
The incidence of fetal low weight, growth retardation, and premature birth will increase significantly. The picture below shows the relationship between the mother's urine protein level and fetal birth weight. We can see that there is a direct linear relationship between urine protein and fetal weight.
The more protein in the mother's urine, the more likely the fetus is to have low weight. urine protein is within 1-2g, especially if the urine protein is less than 1g, the fetal weight is good.
12. Will proteinuria increase after pregnancy?
This picture reflects the general trend of nephrophilic urine protein after pregnancy.
mothers have an average urine protein of about 1g, and the urine protein is relatively stable in the first 3 months. After 3 months, urine protein began to rise slowly, and it became more obvious in the later stages of pregnancy. When it was about to give birth, the urine protein rose to the peak. After giving birth, it began to decline. It was 3 months to a year after delivery. , Urinary protein dropped the fastest, and basically recovered after one year of birth.
13. What should I do if urine protein increases? Is there a cure?
depends on the situation.
Sometimes you can wait. When the doctor thinks that it will not affect the outcome of pregnancy too much, you may wait until after giving birth. Kidney disease is a chronic disease. You can wait for these months after pregnancy. Not all urine protein rises will have to be eaten immediately. Drug treatment.
Sometimes the amount of protein in urine is too large, and it is not possible to survive, so you may use some protein-lowering drugs that pregnant women can use.
14. Which drugs can be used during pregnancy?
hormones, tacrolimus, cyclosporine, hydroxychloroquine, aspirin, nifedipine, labetalol, methyldopa
and ordinary pregnant women can also be used, folic acid, iron, calcium tablets.
These drugs can be used by nephrologists as needed under the guidance of a doctor.
15. Why did my doctor not let me become pregnant when I took high doses of hormones, tacrolimus, and cyclosporine? Hormone
, tacrolimus and cyclosporine are immunosuppressive agents. These drugs are used by patients with a more acute disease and a higher risk of progression. Therefore, the doctor may not consider drug factors, but your kidney disease has not Stable control, not suitable for pregnancy.
16. If hypertension is not well controlled, what will happen to pregnancy?
fetal survival rate is low.
Blood pressure must be controlled well, and if necessary, just use medicine!
17. Which drugs should not be taken during pregnancy?
These drugs increase the risk of fetal teratogenesis:
drugs with "sartan" and "pril" in the name, ACEI and ARB classes: such as benazepril, enalapril, ramipril, valsa Z3z
mineralocorticoid receptor antagonists such as tan, irbesartan, losartan, etc.: such as spironolactone, eplerenone, etc. Flumet
methotrexate
sirolimus (rapamycin)
18. What does " teratogenic " mean?
Congenital malformations, such as cleft lip, cleft palate, heart, limbs, kidneys and other abnormalities
19. Can I use Chinese patent medicines such as Bailing capsules, Jinshuibao, Huangkui capsules for pregnancy?
These drugs have no data during pregnancy and are not recommended.
20. Do you use Tripterygium wilfordii during pregnancy?
is not recommended for
21. After eating sartan and puri, accidentally became pregnant? Children can take it?
It depends on the situation. Generally speaking, if the pregnancy is found early, it is possible to stop the drug in time, and follow up closely in the obstetric department.. The
data on fetal malformations caused by Pristine and Sartan drugs are mainly derived from data in the second and late pregnancy.
Recently, there is some evidence that women stop ACEI drugs in early pregnancy, and does not increase the risk of fetal malformations.
22. How long does it take for immunosuppressants such as cyclophosphamide and mycophenolate to stop before pregnancy?
is generally safe, most immunosuppressants require at least 3-6 months or more.
23. Before pregnancy, how long should sartan and pristine be stopped?
Theoretically speaking, sartan and prisine can be stopped.
24. Will kidney disease be inherited? Most of
will not.
These nephrologists are likely to be passed on to the next generation: polycystic kidney disease, alport syndrome, people with multiple family members suffering from kidney disease, etc. Seek a nephrologist with experience in genetic counseling before pregnancy.
25. Can patients with uremia become pregnant?
has, but relatively few. Because patients with end-stage renal failure, the chance of getting pregnant is relatively small, and the patients have more complications. A successful delivery requires the support of many academic experts.
After a kidney transplantation, the chance of pregnancy will increase.
This article has checked a lot of literature and answered many patients’ concerns. Friends are welcome to forward this article to friends in need~
