Pregnancy does not adversely affect renal transplant function

Women with functioning transplanted kidneys often become fertile again. Ind eed, renal function, endocrine status and libido rapidly improve after rena l transplantation, and 1:50 women of childbearing age become pregnant. Howe ver, there is concern regarding the haemodynamic changes of pregnancy, whic h could lead to a decline in graft function (temporary or permanent). We ex amined obstetric data and renal parameters in 29 patients and 33 pregnancie s. Mean serum creatinine and creatinine clearance remained stable throughou t pregnancy and 1 year postpartum. However, there was a significant increas e in proteinuria from a mean of 0.45 g/24 h around the time of conception t o 1.11 g/24 h at delivery (p<0.05). The proteinuria resolved to baseline le vels at 3 months postpartum. We highlight certain parameters to be consider ed before conception to allow a good obstetric outcome and prolong stable r enal function: serum creatinine <150 mu mol/l, proteinuria <1g/day, absence of histological evidence of chronic allograft rejection, controlled blood pressure (140/90) and stability of maintenance immunosuppression.