Pregnancy outcome in women with reflux nephropathy and the inheritance of vesico-ureteric reflux

In women with reflux nephropathy, we investigated whether pre-existing hype rtension and impaired renal function influence the rates of preeclampsia, r enal function deterioration and preterm birth. The infants were investigate d for vesico-ureteric reflux (VUR). A prospective audit of 54 pregnancies i n 46 women with reflux nephropathy was performed. Preeclampsia complicated 24% of pregnancies and was increased in women with pre-existing hypertensio n (42%) compared with normotensive women (14%), (RR 3.0 (95% CI 1.1-7.8)). Nine (18%) women experienced deterioration in renal function during pregnan cy. Women with mild or moderate renal impairment were at increased risk of renal function deterioration (RR 12.7(95% CI 1.6-98.5); RR 19.8 (95% CI 2.6 -155)), respectively. A third of infants were delivered preterm. The risk o f preterm birth was increased if the mother had pre-existing hypertension ( p = 0.01) or moderate renal impairment (p = 0.002). Seventeen (43%) of the 40 infants who underwent micturating cystourethrography had WR, consistent with autosomal dominant inheritance with reduced penetrance. In reflux neph ropathy, pre-existing hypertension was associated with an increased risk of preeclampsia and pre-existing renal impairment with deterioration in renal function. Infants of women with reflux nephropathy should be screened for WR.