Kidney Matters - Issue 1, Spring 2018

protein in the urine. Since delivering the baby is the only cure for
pre-eclampsia, women with this condition are more likely to have a
premature baby who therefore has a higher risk of poor outcomes.
Another reason for careful planning is that some medicines commonly
used in kidney disease should not be taken during pregnancy. These
medicines include the immune-suppressants cyclosphosphamide,
methotrexate and mycophenolate, as well as rituximab and belimumab.
ACE inhibitors like ramipril and lisinopril and ‘ARBs’ like losartan and
irbesartan are also not recommended. Women planning a pregnancy
should switch to other blood pressure-lowering drugs to make sure that
their blood pressure is well controlled.
“I recommend waiting until you are doing well on these alternative,
safer medicines before you try for pregnancy. If you discover you are
pregnant in the meantime, never stop any of your medicines without
talking to your doctor,” advises Liz.
“The good
news is that,
by planning
ahead, many
women with
kidney disease
can become
pregnant and
have a healthy
baby”
Soraya’s story
Soraya Kadri, aged 30, gave birth to twins
Amelie and Albie in February 2017, nearly
three years after her kidney transplant.
Soraya says: “I planned my pregnancy, and
before I got pregnant my immunosuppression
was changed to avoid mycophenolate. During
my pregnancy, I had regular appointments
with a specialist obstetrician as well as my
kidney doctor. I had to have a caesarean,
and during the operation one of transplant
surgeons was there to make sure that my
kidney was not harmed. It wasn’t an easy
pregnancy and the twins were premature, but
they are fine now and I have better kidney
function than before I became pregnant and
gave birth!”
After being diagnosed with CKD due to
IgA nephropathy when she was 20 and at
university, Soraya received a kidney transplant
from her father. Sadly, the transplant failed
after a year and she needed dialysis. Family
and friends offered to donate a kidney, but
none were a match. In 2014, Soraya received
a kidney from an altruistic donor through the
paired donation scheme.
Pregnancy and birth
Some women with kidney disease may need to give birth by caesarean
section—for example, if they develop early pre-eclampsia. However,
assuming that all goes well during pregnancy, most women can have a
normal vaginal delivery.
Kidney transplantation
Most doctors advise delaying pregnancy for at least one year after a
kidney transplant. Liz emphasises that prednisolone, azathioprine,
tacrolimus and ciclosporin can all be taken during pregnancy. “If
you want to, you can also breastfeed while taking these drugs.
Mycophenolate is the only drug that you should absolutely avoid while
breastfeeding,” she adds.
www.kidneycareuk.org Issue 1 Spring 2018 13