Can Women with Chronic Glomerulonephritis Safely Conceive and Carry a Healthy Pregnancy?
Understanding Fertility and Pregnancy Readiness in Chronic Glomerulonephritis
Yes—many women diagnosed with chronic glomerulonephritis (CGN) can safely conceive, carry, and deliver healthy babies—but only when kidney function is carefully assessed and optimally managed before and throughout pregnancy. Unlike acute kidney conditions, CGN is a long-term inflammatory disorder affecting the glomeruli—the tiny filtering units of the kidneys. Because pregnancy places additional physiological stress on renal and cardiovascular systems, preconception planning is not just advisable—it's essential.
The Critical Role of eGFR in Pregnancy Decision-Making
The single most important metric for evaluating pregnancy readiness is the estimated Glomerular Filtration Rate (eGFR). This value reflects how efficiently your kidneys filter waste from the blood. It's calculated using serum creatinine levels, along with age, sex, race, and body size—often via the widely accepted CKD-EPI equation. For greater precision, some specialized centers may use technetium-99m DTPA or MAG3 renal scintigraphy (ECT scan), which provides a direct, split-kidney measurement of filtration capacity.
What eGFR Thresholds Mean for Pregnancy Planning
An eGFR ≥ 60 mL/min/1.73m² generally indicates stable, mild-to-moderate kidney function—and is considered the safest range for conception. When combined with well-controlled proteinuria (urine protein < 0.5 g/day) and optimal blood pressure (< 120/80 mmHg, per current AHA/ACC guidelines), the risks of maternal complications (e.g., preeclampsia, worsening renal function) and adverse fetal outcomes (e.g., preterm birth, low birth weight) remain low.
In contrast, an eGFR between 45–59 mL/min/1.73m² warrants cautious, individualized counseling. While pregnancy isn't automatically contraindicated, it requires close collaboration among a nephrologist, maternal-fetal medicine specialist, and primary care provider—including rigorous monitoring of renal biomarkers, urine albumin-to-creatinine ratio (UACR), and serial ultrasounds.
An eGFR < 45 mL/min/1.73m² signals significantly reduced kidney reserve. In this scenario, pregnancy carries substantially elevated risks—including rapid progression to end-stage kidney disease, severe hypertension, and intrauterine growth restriction. Most international guidelines, including those from KDIGO and the European Renal Association, strongly advise delaying or avoiding pregnancy until kidney function stabilizes—or until after successful kidney transplantation.
Key Preconception & Prenatal Considerations
Beyond eGFR, several other factors must be optimized before attempting conception: avoiding teratogenic medications (e.g., ACE inhibitors, ARBs, mycophenolate), ensuring adequate folate intake, screening for comorbidities like diabetes or autoimmune disorders, and confirming stable immunosuppressive regimens if applicable. Regular prenatal visits should include monthly eGFR tracking, 24-hour urine protein quantification, and Doppler ultrasound assessments of uteroplacental blood flow starting in the second trimester.
With thoughtful preparation, multidisciplinary support, and evidence-based monitoring, many women with chronic glomerulonephritis go on to experience fulfilling, low-risk pregnancies—and become joyful, healthy parents.