CKD pre-pregnancy counselling — ESENeph MCQ

Correct answer: A — Stop ramipril before conception

ACE inhibitors are avoided in pregnancy and should be stopped before conception or as soon as pregnancy is recognised, with alternatives such as labetalol or nifedipine used when needed. Spironolactone and mycophenolate are not appropriate pre-pregnancy substitutions. CKD increases pregnancy risk and warrants pre-pregnancy counselling. The pearl is that proteinuric CKD requires coordinated renal-obstetric care even when baseline eGFR is preserved. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: UKKA Clinical Practice Guideline on Pregnancy and Renal Disease; BNF: https://ukkidney.org/health-professionals/guidelines/clinical-practice-guideline-pregnancy-and-renal-disease