Risks and Complications of Chronic Glomerulonephritis During Pregnancy

During pregnancy, a woman's body undergoes significant physiological changes, particularly in the cardiovascular and renal systems. One of the most notable adaptations is the increase in total blood volume, which can rise by up to 50% compared to non-pregnant levels. This expansion leads to a decrease in plasma colloid osmotic pressure and causes both afferent and efferent arterioles in the kidneys to dilate. As a result, the glomerular filtration rate (GFR) increases substantially—often exceeding normal values by more than 50%. These changes place considerable stress on the kidneys, even in healthy women.

Physiological Kidney Changes in Pregnancy

The structural adaptations in the urinary system during gestation include dilation of the renal pelvis and calyces, along with increased capillary permeability in the glomeruli. Due to these alterations, it's common for pregnant women to exhibit mild, transient proteinuria—typically less than 300 mg per day—which is considered a normal physiological response rather than a sign of pathology.

However, when pre-existing kidney disease such as chronic glomerulonephritis is present, this natural strain on the renal system can be dangerously amplified. The kidneys, already compromised by inflammation and scarring of the glomeruli, may struggle to cope with the heightened demands of pregnancy, leading to accelerated deterioration of renal function.

Risks for Women with Chronic Glomerulonephritis

Elevated Blood Pressure and Proteinuria: Key Warning Signs

Women with chronic glomerulonephritis should only consider pregnancy when their condition is well-managed. Ideally, blood pressure should be consistently below 140/90 mmHg, and proteinuria should be minimal or stable. If hypertension persists above 150/100 mmHg, especially in conjunction with impaired kidney function, the risks of adverse outcomes—including preterm delivery, miscarriage, and intrauterine growth restriction—rise significantly.

Uncontrolled hypertension not only threatens maternal health but also increases the likelihood of developing preeclampsia—a serious pregnancy complication characterized by high blood pressure and signs of organ damage, often affecting the liver and kidneys.

Potential for Severe Maternal and Fetal Complications

Pregnant women with underlying glomerular disease are at higher risk of experiencing preeclampsia, which can progress to eclampsia or lead to placental abruption—the premature separation of the placenta from the uterine wall. This life-threatening condition can result in fetal distress, stillbirth, or emergency cesarean delivery.

Moreover, the added cardiovascular burden may trigger serious maternal events such as stroke, heart failure, or acute kidney injury. Studies show that women with baseline serum creatinine levels above 1.4 mg/dL before conception face an even greater risk of long-term renal decline post-pregnancy.

Recommendations for Safe Pregnancy Planning

To minimize risks, comprehensive preconception counseling is essential. This includes thorough evaluation of kidney function, blood pressure control, medication review (especially discontinuation of teratogenic drugs like ACE inhibitors or ARBs), and close monitoring by a multidisciplinary team including nephrologists and maternal-fetal medicine specialists.

Early and regular prenatal care allows for timely intervention, helping to optimize outcomes for both mother and baby. With proper management, many women with stable chronic glomerulonephritis can have successful pregnancies—but careful planning and ongoing surveillance are critical.

In conclusion, while pregnancy itself places a heavy load on the kidneys, coexisting chronic glomerulonephritis magnifies these challenges. Ensuring optimal health before conception and maintaining strict control over blood pressure and proteinuria throughout gestation are vital steps toward reducing complications and supporting a safer pregnancy journey.