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CKD eGFR Partial Recovery Postpartum — ESENeph MCQ

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ModeratePregnancy & RenalCKD eGFR Partial Recovery PostpartumESENeph

A 33-year-old woman at 30 weeks' gestation with pre-existing CKD G2 (baseline eGFR 75 mL/min/1.73m2) secondary to IgA nephropathy is found to have eGFR declining to 58 mL/min/1.73m2. Her proteinuria has increased from uPCR 35 to 120 mg/mmol. BP is 138/86 mmHg on labetalol. She was on ramipril before pregnancy. What is the expected trajectory of her eGFR postpartum?

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Correct answer: D — Partial recovery likely but some permanent eGFR loss may occur

In women with CKD, pregnancy-related eGFR decline is multifactorial: haemodynamic changes, increased proteinuria from hyperfiltration, RASi withdrawal, and potentially superimposed pre-eclampsia. Postpartum, partial eGFR recovery is typical as haemodynamic changes reverse, RASi is restarted, and pregnancy-related hyperfiltration resolves. However, some permanent eGFR loss may occur, particularly in women with CKD G3b+ or heavy proteinuria. The Bramham et al and Piccoli et al studies showed that pregnancy in CKD carries a real risk of accelerating disease progression, though the magnitude varies. Postpartum monitoring with serial eGFR and prompt RASi reinstitution is essential.

Reference: https://guidelines.ukkidney.org