Very detailed! Preparations for female kidney patients before pregnancy

Whether a female kidney disease patient can successfully become pregnant is closely related to whether the pre-pregnancy preparation is sufficient. Most kidney diseases are chronic diseases that progress slowly. How to choose the right time for pregnancy is an important factor in whether the pregnancy is successful and whether pregnancy will aggravate the kidney disease of the expectant mother. Before planning a pregnancy, be sure to tell your doctor, fully communicate with your nephrologist, and make adequate preparations. Pre-pregnancy preparation mainly includes the following aspects.

Choosing the right time to get pregnant

1. Most patients with minimal change nephropathy are sensitive to hormones, and adequate hormone treatment can alleviate the disease in a short period of time. This disease is prone to relapse, but even if it relapses during pregnancy, hormones are still effective. For example, membranous nephropathy has a slow onset, and hormone and immunosuppressant treatments are slow to take effect, and it often takes several months of treatment to alleviate the disease. If such patients plan to get pregnant, do not rush to stop or reduce medication. It is more appropriate to get pregnant after the nephrotic syndrome is completely relieved and the treatment is consolidated.

2. Autoimmune kidney disease (IgA nephropathy) is a slowly progressive disease that is prone to hypertension and renal insufficiency during pregnancy. For women with hematuria with or without mild proteinuria, normal blood pressure and renal function, it is recommended to get pregnant as soon as possible if they are planning to have a baby. If the 24-hour urine protein exceeds 1 gram, it is advisable to treat the kidney disease first, and consider pregnancy when the 24-hour urine protein is stable below 0.5 grams.

3. Patients with lupus nephritis can get pregnant, but they should be cautious and wait until the disease is completely relieved for half a year before getting pregnant with the doctor's consent. During the entire pregnancy, they should be closely monitored by a nephrologist and given appropriate treatment.

Pregnancy in patients with chronic kidney disease can easily lead to decreased renal function. If renal insufficiency already exists before or in early pregnancy, renal function is very likely to deteriorate further in late pregnancy, making normal pregnancy and childbirth almost impossible. Therefore, those who already have obvious renal abnormalities before pregnancy should not get pregnant. Even if renal function is slightly abnormal, the risk of pregnancy will be significantly increased, and whether to get pregnant should be carefully decided based on the specific situation.

Fully assess the condition and systemic condition before pregnancy Before pregnancy, the condition of the kidney disease patient should be fully assessed to see if it is suitable for pregnancy. Rash pregnancy often goes against one's wishes. Not only can the goal of having a healthy baby not be achieved, but it may also cause severe trauma to the mother and family with kidney disease. The main factors affecting whether kidney disease patients can get pregnant include proteinuria, blood pressure and renal function status , of which the latter two are decisive factors. Before pregnancy, the kidneys should be fully examined, including urine routine, 24-hour urine protein quantification, whether there is hypertension and renal insufficiency, etc. For patients with lupus nephritis, in addition to evaluating the condition of kidney disease, the activity of systemic lupus should also be systematically estimated (including clinical manifestations of lupus, erythrocyte sedimentation rate, immunoglobulin, and multiple immune indicators, etc.). Before pregnancy, the doctor should fully communicate with the patient to explain the possible risks to the mother and baby during pregnancy, as well as relevant precautions.

Adjust the treatment drugs before pregnancy . Glucocorticoids and immunosuppressants used to treat kidney disease, such as prednisone, methylprednisolone, cyclophosphamide, and tripterygium wilfordii polyglycosides, can disrupt the menstrual cycle of female patients or even cause amenorrhea, making pregnancy difficult. If you are taking hormones, immunosuppressants, or drugs such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, be sure to tell your doctor about your plan to have a baby 3 to 6 months in advance. The doctor will tell the female patient whether she can have a child based on the amount of urine protein, blood pressure control, and renal function. If the condition allows pregnancy, the doctor will adjust the treatment drugs and replace drugs that may affect the fetus with drugs that have no effect on the fetus or have as little effect as possible.

While waiting for pregnancy, if the medications you are taking may have a negative effect on your fertility, you cannot simply stop taking them on your own. Instead, you need to weigh the possibility of fertility problems against the effects of these medications on the disease. If you stop taking medications on your own regardless of the severity of your kidney disease, the likelihood of having a successful baby after your kidney disease becomes severe will be even lower. Therefore, you must consult a nephrologist before planning a pregnancy to ensure that you make the right choice for your condition at the time.

In short, it is not an easy thing for patients with kidney disease to plan pregnancy. If you want to get pregnant, you must first understand whether your condition allows it. If your condition is stable, and your blood pressure and kidney function are normal, you can make a decision after consulting a nephrologist. After deciding to get pregnant, the nephrologist will adjust the treatment drugs, stop using drugs that have an impact on the fetus, or switch to drugs that have no effect on the fetus or have the least effect possible. And after pregnancy, you should go to the hospital for regular check-ups. Not only does the obstetrician need to closely monitor the baby's development, but the expectant mother should also go to the nephrology department to monitor urine protein, blood pressure and kidney function, and observe the impact of pregnancy on the kidneys, so as to detect problems early and deal with them in time.