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CKD G4 Pregnancy Risk — ESENeph MCQ

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ModeratePregnancy & RenalCKD G4 Pregnancy RiskESENeph

A 30-year-old woman with known reflux nephropathy and CKD G4 (eGFR 22 mL/min/1.73m2) wishes to become pregnant. Her BP is 128/78 on Labetalol. Proteinuria is 0.5 g/day. She is not on an ACEi/ARB (switched pre-conception). What counselling is essential regarding pregnancy risk?

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Correct answer: B — Pregnancy in CKD G4 carries significantly increased risks including pre-eclampsia, preterm delivery, fetal growth restriction, and accelerated maternal CKD progression

Pregnancy with CKD G4 carries substantial risks: pre-eclampsia (up to 40-60% in advanced CKD), preterm delivery, fetal growth restriction, and risk of accelerated maternal CKD progression. UKKA pregnancy guidelines state that women should be counselled about these risks in a multidisciplinary setting (nephrology, obstetrics, neonatology). Pregnancy is not absolutely contraindicated but requires intensive monitoring. Post-partum renal function may not return to pre-pregnancy baseline.

Reference: UKKA 2019 – Pregnancy in CKD; Wiles et al 2019 – CKD and Pregnancy