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IgAN Pre-Conception Counselling — ESENeph MCQ

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ModeratePregnancy & RenalIgAN Pre-Conception CounsellingESENeph

A 30-year-old woman with IgA nephropathy is considering pregnancy. Her eGFR is 68 mL/min/1.73m2 and proteinuria is 0.4 g/day on Ramipril 5 mg. Her BP is 120/76. What pre-conception advice should she receive?

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Correct answer: B — Switch Ramipril to Labetalol pre-conception; ensure proteinuria <1 g/day and stable eGFR; aim for disease quiescence before conceiving

KDIGO 2025 IgAN guideline and UKKA pregnancy guidelines recommend that women with IgAN planning pregnancy should: (1) switch ACEi/ARB to a pregnancy-safe agent (Labetalol, Nifedipine) before conception; (2) ensure disease is as quiescent as possible (proteinuria <1 g/day, stable eGFR, controlled BP); (3) have pre-conception counselling about pregnancy risks (pre-eclampsia, preterm delivery, CKD progression). SGLT2i should also be stopped before/at conception as safety data in pregnancy is lacking.

Reference: KDIGO 2025 – IgAN; UKKA 2019 – Pregnancy in CKD