After a kidney transplant an uncomplicated pregnancy with birth to date is often possible in the following situations:
A pregnancy worsens kidney disease not always. It seems that it only leads to exacerbation of non-infectious kidney disease when addition is a non-controlled hypertension. Often an existing before pregnancy significant renal insufficiency (serum creatinine> 3 mg / dL [> 270 mol / l] or serum urea> 3 mg / dL [> 270 mol / l]), however, prevents a pregnancy usually up will be held for the appointment. Maternal renal insufficiency can lead to fetal growth retardation and stillbirth. After a kidney transplant an uncomplicated pregnancy with birth to date is often possible in the following situations: The transplanted kidney has already been> 2 years present normal renal function No phases of rejection Normal blood pressure The treatment requires close-knit representations to a nephrologist. Blood pressure and weight are measured every 2 weeks; Serum urea and creatinine must be assessed together with the creatinine clearance often, the frequency is dictated by the severity and progression of the disease. Furosemide is used only when necessary to control blood pressure and severe edema; some women need other drugs for blood pressure control. Women with severe renal impairment sometimes need after the 28th week of pregnancy a hospital stay to comply with bed rest, blood pressure checks and intensive fetal surveillance. If the results of prenatal tests normal and unremarkable, the pregnancy is continued. Usually a birth before the appointment is necessary when a pre-eclampsia develops fetal growth or uteroplacental hypoperfusion. In some cases, an amniocentesis to assess fetal lung maturity can bring a decision on the date of confinement; a lecithin / sphingomyelin ratio> 2: 1, or the presence of phosphatidylglycerol confirmed maturity. Very often a Caesarean section is performed, although a vaginal birth would be possible if the cervix is ??ripe and there are no obvious barriers to vaginal delivery. Stage renal disease advances in dialysis treatment have increased the life expectancy of patients with end stage renal disease, improves pregnancy outcomes and fertility increased. The survival rate of fetuses of pregnant women who are receiving hemodialysis has risen from 23% (about 1980) to currently almost 90% improved. The reason probably lies in a significant increase in Hämodialysedosis during pregnancy; Today a high-flux, high-efficiency hemodialysis is usually 6 times / week performed. The dialysis can be adjusted on the basis of laboratory, ultrasound and clinical findings (eg. As severe hypertension, nausea or vomiting, edema, excessive weight gain, persistendes polyhydramnios). Although the pregnancy outcomes have improved, the rate of complications in patients remains high with end stage renal disease.