CONTINUING MEDICAL EDUCATION

Renal disease in pregnancy may cause a feeling of trepidation, even in the most experienced physician, and may take several forms. Pregnancy may be the first medical review for women with a previously undiagnosed renal problem. Patients may have pre-existing renal disease, e.g. diabetic nephropathy. Additionally, women with renal transplants and renal diseases, e.g. lupus nephritis, require immunosuppression. Pregnancy outcomes in renal disease are determined by baseline creatinine levels, hypertension and degree of proteinuria. The risk of progression of chronic kidney disease (CKD) and maternal and fetal complications increases as the renal function worsens, and patients need to be counselled, preferably prior to conception. Pre-existing renal disease predisposes to pre-eclampsia, a condition occurring in up to 5 % of pregnancies, making it one of the most commo