Insights into the impact of pregnancy on kidney disease

Overview

Studies in 2022 have advanced knowledge of pregnancy outcomes in kidney donors and transplant recipients as well as the long-term risks associated with hypertensive disorders of pregnancy. These findings should be used to support shared decision-making and appropriate care of women with or at risk of kidney disease.

Key advances

Living kidney donors have a low absolute risk of adverse pregnancy events; discussion of risk should be individualized and desire for future pregnancy should not be a barrier to donation.

Pre-donation pregnancy complications were not associated with increased cardiovascular risk or reduced long-term kidney function in kidney donors; however, donors should receive ongoing follow-up for kidney disease, hypertension and diabetes.

In the general population, hypertensive disorders of pregnancy conferred a 2–3-fold increased risk of incident chronic kidney disease that was observed within 3 years of delivery and exacerbated by racial and sociodemographic factors.

Pregnancy after kidney transplantation can be complicated but has a high likelihood of excellent outcomes; preconception kidney function is the main driver of pregnancy outcomes and graft loss.