Post Date December, 03 2023
Many women of childbearing age are very depressed after getting sick, but in fact, chronic kidney disease is not a taboo for pregnancy. Many patients can conceive and give birth smoothly after their condition stabilizes, and it does not affect long-term kidney function.
Generally speaking, patients with stage 1-2 renal function have good blood pressure, less than 1g of urine protein, and a successful delivery rate of over 95%, with no or minimal impact on renal function. However, renal function in stages 3-5 can easily lead to the recurrence and worsening of existing kidney disease (especially in patients with lupus nephritis), which may worsen renal function damage and increase the risk of end-stage renal failure. Therefore, pregnancy is generally not recommended.
During pregnancy, careful and reasonable medication has a significant impact on both mother and child. Let's take a look at these medications together!
1. Antihypertensive drugs
Priles and sartans are the most commonly used antihypertensive drugs for kidney disease, but they are pregnancy drugs that need to be discontinued when preparing for pregnancy.
If pregnancy is discovered while taking medication, generally speaking, within one month of pregnancy, the medication taken has or has no effect, showing two possibilities. If there is an effect, it will cause spontaneous abortion, and if there is no effect, the fetus will continue to grow up healthy.
During pregnancy, if high blood pressure occurs, antihypertensive drugs that can be used include central antihypertensive drugs such as methyldopa, β Receptor blockers such as rabelol, calcium channel blockers such as nifedipine sustained-release tablets (but nifedipine controlled-release tablets are prohibited for pregnant women within 20 weeks of pregnancy).
Diuretics may cause potential water electrolyte disorders and should generally be avoided.
2. Immunosuppressants
In principle, glucocorticoids cannot be used, but if unavoidable, in addition to dexamethasone and betamethasone, other glucocorticoids can be inactivated by the placenta and can be maintained in low doses for treatment. However, strict monitoring of the mother and fetus must be carried out during the medication period.
Immunosuppressants, calcineurin inhibitors (cyclosporine A, tacrolimus, rapamycin), and anti metabolic drugs (azathioprine) are considered safe and used to monitor blood drug concentrations.
However, nucleotide synthesis inhibitors (cyclophosphamide, mycophenolate mofetil, leflunomide, etc.) are listed as pregnancy contraindications due to their teratogenic effects. Women who use mycophenolate mofetil should stop taking the medication for more than 6 weeks before conception.
There is also widespread use of hydroxychloroquine, and the safety of pregnancy use is still controversial. According to the 2012 KDIGO Guidelines for Improving the Prognosis of Kidney Disease, lupus patients who do not use such drugs before pregnancy are not recommended to use them during pregnancy; But if hydroxychloroquine has been taken before pregnancy, it should continue to be taken during pregnancy, otherwise the probability of lupus recurrence and miscarriage after discontinuing the medication is much higher than the neonatal malformation caused by the medication.
3. Lipid-lowering drugs
Generally avoid using.
4. Anticoagulant drugs
Heparin anticoagulants can be used as they do not cross the placenta;
Coumarin anticoagulants, such as warfarin, can affect organ development during organogenesis (6-8 weeks of pregnancy) and should be avoided; Anti platelet aggregation drugs such as dipyridamole and clopidogrel are not recommended for use.
5. Antibiotics
At present, there are no antibiotics that can guarantee complete harmlessness. When infected, it is necessary to weigh the pros and cons of using them, such as cephalosporins, azithromycin, etc.
Antibiotics to avoid include aminoglycosides, tetracyclines, terbinafine, furantoin, sulfonamide/trimethoprim. Completely prohibited include quinine, ethionimide, and ribavirin.
6. Other commonly used drugs
Folic acid needs to be replenished for the first three months. Calcium and iron agents should be supplemented according to the situation.
If you want to conceive, if your condition stabilizes, you should conceive as soon as possible and drag on until you get older. Just being older increases the risk of related complications.
During pregnancy, follow the required prenatal examination, regularly review kidney related indicators, maintain a happy mood, exercise appropriately, eat a balanced diet, and have confidence in yourself and your baby!
