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Contraception in CKD — ESENeph MCQ

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HardSexual Health and Kidney DiseaseContraception in CKDESENeph

A woman with CKD G3b, hypertension, ACR 65 mg/mmol and migraine with aura wants reliable reversible contraception for several years. Which approach is most appropriate?

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Correct answer: BOffer a progestogen implant or intrauterine system

The best answer is “Offer a progestogen implant or intrauterine system”. The UK renal-pregnancy guideline supports the progestogen-only pill, implant and intrauterine system in CKD. Long-acting methods fit the reliability preference, while oestrogen-related thrombosis and blood-pressure risks matter in this case. “Use combined oestrogen-progestogen contraception as the preferred method” is less appropriate because hypertension, vascular risk and migraine with aura make oestrogen-containing methods unsuitable “Avoid contraception because fertility is reduced in CKD” is less appropriate because unintended pregnancy occurs in CKD and requires active prevention when pregnancy is not desired “Use mycophenolate as a contraceptive medicine” is less appropriate because mycophenolate is teratogenic immunosuppression and does not prevent conception “Exclude every intrauterine method because CKD raises infection risk” is less appropriate because the UK renal-pregnancy guideline considers the progestogen intrauterine system safe and effective

Reference: UK clinical practice guideline on pregnancy and renal disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC6822421/