11 - Drugs in women with renal disease and transplant recipients in pregnancy

Summary

Introduction

An international survey reported that over 80% of unselected pregnant women use over-the-counter or prescribed medicines during pregnancy. Almost all women known to suffer from renal disease require antenatal drug treatment. Most drugs are started prepregnancy for the underlying condition or comorbidity.

This chapter focuses on immunosuppressive agents used by women in the treatment of renal disease as well as erythropoietic-stimulating agents (ESAs) and diuretic agents. Antihypertensive agents are frequently required by people with chronic kidney disease (CKD) and are covered in Chapter 12 on treatment of hypertension in renal disease. For discussion on use of antibiotics in this setting, see Chapter 17.

Prepregnancy counselling is critical to safe and effective drug use in pregnancy by women with known renal disease. Consideration of the risk—benefit balance to both mother and fetus surrounding the initiation or stopping of drug treatment prepregnancy or during pregnancy is a key challenge for the multidisciplinary team caring for these women.

Search strategy

The evidence base available to guide women in this area is limited and relies on case reports, incomplete registry data, case—control series and non-controlled meta-analysis. These were identified from a PubMed search, relevant review articles, TOXbase, the National Teratology Information Service (NTIS), Micromedex, the British National Formulary (BNF 55 (March 2008); Appendix 4), reference guides, expert opinion and relevant pharmaceutical company pregnancy databases.