If you are already pregnant, the very best thing you can do for you and your baby is to get early, comprehensive prenatal care. Your care during this time is critical in determining your health status and degree of kidney function in order to more accurately determine if your kidney status is changing or worsening. Management of your care will most likely include a perinatologist, nephrologist (kidney specialist), and neonatologist (high-risk newborn specialist).

Your first prenatal visit will include a thorough history and physical along with routine prenatal laboratory blood work and kidney function blood work. You will also be asked to obtain a twenty-four hour urine sample to be brought back to the laboratory for evaluation of the total amount of protein and creatinine in your urine. Early in pregnancy, an ultrasound will be done to confirm or establish an accurate gestational age for your baby.

Routine prenatal visits will occur every two weeks until thirty-two weeks gestation, as long as there are no complications. Each visit will include: obtaining a urine sample to dip for protein, glucose, and signs of UTI; taking your blood pressure; obtaining your weight; and generally assessing how things are going. For those with kidney disease, monthly twenty-four hour urine tests will be done and compared to previous tests. If tests show a trend of increasing protein in the urine, this is a sign of worsening kidney disease. Frequent blood tests to assess for any increase in blood urea nitrogen (BUN, for short) and creatinine will also be done. These two substances will increase in your blood if kidney function is diminishing.

At approximately twenty weeks gestation, the baby will be looked at closely, from head to toe, assessing its size, its organ development, and its growth. Beyond twenty-four weeks gestation, you will begin having serial ultrasounds, meaning that the baby will be frequently assessed by ultrasound for growth. During these ultrasounds, the amniotic fluid volume is assessed to see if it is too low, and the placenta will be assessed for signs of premature aging. Both of these can help identify problems of worsening maternal disease and, subsequently, how well or poorly the baby is tolerating the changes.

High blood pressure (hypertension) in chronic kidney disease is very common. One of the major goals throughout your pregnancy will be to keep your blood pressure under control. If you've had kidney disease for any length of time, you usually have high blood pressure also.

The pregnant woman with underlying kidney disease or chronic high blood pressure is at significantly greater risk for preeclampsia. Briefly, preeclampsia is a disease of pregnancy which can cause very high blood pressure, worsening kidney disease, liver disease, seizures, and stroke. Additionally, it can cause severe growth restriction and a potentially poor outcome for the baby, including severe prematurity and death. In a woman with kidney disease, preeclampsia can occur earlier in pregnancy than with other women, and it can be much more severe. Termination of the pregnancy is recommended in cases in which preeclampsia occurs at less than twenty-four weeks gestation. This may seem like a harsh solution, but in these circumstances, the mother is at risk for dying as a result of her high blood pressure and preeclampsia, and the baby, having lived in a uterus with minimal blood flow due to the high blood pressure and other problems with its placenta, will be very small for its age and will most likely not survive.

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I would like to say that my daughter's prenatal care included none of the above. We were not then, nor are we now satisfied with the care that my daughter recieved from her ob. Her ob was told that she was being tested for kidney problems, and his response to her was "you pregnant, what you expect". This was his response to every symptom or complaint that she had during pregnancy. He told her that her kidneys were fine, that she didn't need any further testing or care. The day of my daughter's baby shower in July of 2001, I became alarmed at the severity of the swelling in her ankles. When she called her ob, his response was once again, "you pregnant, what you expect?".  I believe she had pre-eclampsia then. Cody was born with absolutely NO amniotic fluid, and had he been closely monitored as he should have been, perhaps he could have been delivered earlier, and would be alive today.