Pregnancy and Chronic Kidney Disease

One of the best experiences of my nephrology fellowship was attending the high-risk obstetrics clinic at the University of Chicago under the tutelage of Marshall Lindheimer, MD. The patients were all interesting, the clinical problems complex, the collegial atmosphere simultaneously supportive and intellectually stimulating. I continue to be challenged by the issues of pregnancy in chronic kidney disease (CKD) and over the years have relied on the small but dedicated group of nephrologists writing and speaking about pregnancy in CKD to help me care for pregnant patients in my CKD and transplant clinics and dialysis units. In this issue of Advances in Chronic Kidney Disease, we provide a “how to” manual for providers caring for women with CKD who are or wish to become pregnant. The issue begins with an historical overview by Susan Hou, a nephrologist who has compiled and communicated much of the registry data on pregnancy in CKD and who has served as a mentor for many in this field. Reviews of sexuality in CKD by Ananthatanam and Schmidt and counseling about pregnancy and contraception by Watnick emphasize the need for nephrologists to understand these issues to provide relevant information to their patients. Michael Fisher reviews the epidemiology of pregnancy in CKD, focusing on the outcomes of mother and child throughout the CKD spectrum. Management strategies for the pregnant dialysis and transplant patient are provided by Reddy, Josephson, and McKay and will undoubtedly serve as general practice guidelines for the care of these patients. Since prescribing medications for use by pregnant women is an issue in itself, Jason Umans gives an overview of antihypertensives and immunosuppressives in this population. The important topic of hypertension in pregnancy is addressed by Podymow and August, and what little is known about long-term consequences to the infants born to women with CKD is reviewed by Blowey and Warady. During review of the manuscripts, the usefulness of an article devoted to the obstetric aspects of pregnancy in CKD became clear, and I thank Judy Hibbard and Maria del Mar Conlon for agreeing to write this article with very little notice. To complete the issue, Sara Davison addresses the ethical issues raised by pregnancy in CKD.

Perhaps the most important contributors to the issue are unrecognized. They are the peer reviewers, the dedicated, busy professionals who graciously donated their time, curiosity, and intellect. Because the group of professionals studying and writing about pregnant women with CKD is relatively small, many of the authors also served as peer reviewers for this issue. I thank them for their willingness to contribute to all aspects of this issue. As noted by many of the authors, much is yet to be done to enrich our understanding of many aspects of pregnancy and CKD, so that we may better inform, counsel, and care for our patients. I hope this issue serves as a stimulus for investigative efforts by young nephrologists. Finally, I acknowledge the patients and their families who inspired the contributions in this issue, and I thank Marshall Lindheimer, who introduced me to this fascinating, anxiety-provoking, yet rewarding aspect of nephrology so many years ago.