5 - Postpartum follow-up of antenatally identified renal problems

Summary

Introduction

Some renal problems are more likely to be diagnosed in pregnancy than others. Urinary abnormalities will almost always be detected as a result of the near universal application of urinary dipstick testing throughout pregnancy. Renal dysfunction without associated urine abnormalities may be less likely to be diagnosed as the biochemical profile is not part of routine booking blood work. However, serum creatinine is usually measured in women who present with urine abnormalities, hypertension/pre-eclampsia and/or recurrent urine infections as well as unexplained severe anaemia. Thus pregnancy provides an opportunity to identify women with hitherto undiagnosed or new-onset kidney problems. How these women should be followed up postpartum depends on the presentation and the severity.

There are some basic principles that should be followed. All women found to have a renal problem need to have a renal diagnosis made, ideally during pregnancy but certainly postpartum where that is not practical. For instance, during pregnancy this may be a simple matter of the woman having a renal ultrasound that demonstrates scarred kidneys from recurrent urinary tract infections (UTIs) and hypertension, confirming the diagnosis of reflux nephropathy. In other circumstances diagnosis might not be confirmed during pregnancy because of the requirement for tests that pose an unacceptable risk to the mother or baby, for example certain forms of imaging. A woman who presents with modest proteinuria in early pregnancy with no hypertension, with normal function and with no markers of systemic disease would not warrant a renal biopsy during pregnancy as diagnosis will not alter management. However, if the proteinuria persists postpartum, then she may well merit biopsy to determine diagnosis and prognosis, not least for future pregnancies.