The kidneys and pregnancy affect each other in both directions. If you have had pre-eclampsia, your risk of kidney disease later in life is higher, and if you have kidney disease, pregnancy is more demanding. With good planning and close follow-up, most pregnancies go well. Here is what you should know, and what you can do.
By the Nyrami editorial teamPublished 7 October 20266 min read
During pregnancy the kidneys work harder than usual. The blood volume rises and the kidneys filter more blood. That is why the kidneys and pregnancy are closely linked: a pregnancy can reveal or strain diseased kidneys, and pre-eclampsia can leave traces in the kidneys and blood vessels long afterwards.
Pre-eclampsia is high blood pressure that starts after week 20 of pregnancy, together with protein in the urine or other signs that organs or the placenta are not working as they should. Three to five in a hundred pregnant women get it. It can cause headache, blurred vision, pain under the ribs and swelling, but many notice little. That is why blood pressure and urine are checked at antenatal appointments.
It raises the risk, but the vast majority never get kidney failure. A large Norwegian study linked the Medical Birth Registry of Norway with the Norwegian Renal Registry and found that women who had pre-eclampsia in their first pregnancy had almost five times the risk of developing severe kidney failure later. The risk was higher the more pregnancies with pre-eclampsia. Because severe kidney failure is rare, the absolute risk is still low.
Pre-eclampsia also raises the risk of high blood pressure and heart and blood vessel disease. High blood pressure is the most common cause of kidney failure in Norway, so this is where you can do the most.
Yes, many can, and most pregnancies go well. But the pregnancy is more demanding, and the risk rises the lower the kidney function, the more protein in the urine and the higher the blood pressure. Pregnant women with kidney disease have a higher risk of pre-eclampsia, premature birth and low birth weight, and kidney function can get worse during pregnancy.
That is why the most important advice is to plan the pregnancy with your doctor, ideally your kidney doctor, before you become pregnant. Then your doctor can assess your kidney function, get your blood pressure well controlled and change medicines that are not safe in pregnancy.
Some medicines that are common in kidney disease should not be used in pregnancy. Do not stop on your own: talk to your doctor before you try to get pregnant, and you will get a safe plan.
You are followed more closely than other pregnant women, often by both an obstetrician and a kidney doctor. Blood pressure, urine and kidney function are measured more often. Chronic kidney disease and a kidney transplant carry a high risk of pre-eclampsia, and the Norwegian Society of Gynaecology and Obstetrics then recommends low-dose aspirin from week 11 to 14 of pregnancy to reduce the risk. This must always be agreed with your doctor.
The blood pressure target is stricter than for other pregnant women. It helps to measure your blood pressure at home and bring the numbers to your appointments.
Yes. Fertility often improves after a successful transplant, and many have children. It is usually recommended to wait until kidney function has been stable for at least a year after the transplant, and immunosuppressants that are not safe in pregnancy must be changed beforehand.
The risk of pre-eclampsia is high. A study from Oslo University Hospital found that almost four in ten first-time mothers with a transplanted kidney got pre-eclampsia, compared with three to five in a hundred in the rest of the population. Almost all of them still had live babies. That is why you are followed especially closely. Read more in Kidney transplant.
It is possible, but less common, because kidney failure lowers fertility. A pregnancy on dialysis is high risk and usually needs more dialysis than normal, often almost daily, and very close follow-up. If you want children and are on dialysis, talk to your kidney doctor about the options, including having a transplant first. See Life on dialysis.
Because it only affects women, and because it has long had too little attention. Pre-eclampsia is often seen as something that is over once the baby is born, but it can be an early warning of high blood pressure and diseased blood vessels. In the 2027 state budget the Norwegian government proposes to double the funding earmarked for research on women’s health. We think the kidneys belong in that research.
If you are pregnant and get a severe headache, blurred vision, pain under the ribs on the right side, sudden swelling of the face or hands or feel unwell, contact the maternity unit or the out-of-hours service straight away on 116 117. If life is at risk, call 113. If you have had pre-eclampsia and have not had your blood pressure checked for several years, book an appointment with your GP.
In the Nyrami app you can track your blood pressure and test results over time and bring the numbers to your doctor. The app also has a food scanner with salt, potassium and phosphorus assessed for you, and is free for iPhone and Android. The app does not replace your antenatal care.
Turns the advice into something you can use in the shop and the kitchen: scan food and see potassium, phosphorus and salt assessed for you, and follow your numbers over time. Free on iPhone and Android.
The digital front line is the Norwegian government’s name for the digital services that will become your first contact with the health service. First is a public AI service on Helsenorge, planned for spring 2027, that will answer questions about symptoms, health problems and test results. Here is what it is, what it may mean for people with kidney disease, and how Nyrami wants to contribute.
No medicine cures chronic kidney disease, but several can slow it down: blood pressure medicines called ACE inhibitors or ARBs, SGLT2 inhibitors such as Forxiga and Jardiance, and in type 2 diabetes also finerenone and semaglutide. Other medicines, such as ibuprofen, must be used with care. Never change anything on your own.
A little alcohol now and then is rarely harmful to the kidneys on its own, but alcohol raises blood pressure, dehydrates the body and interacts with many medicines. With kidney disease it is therefore wise to drink little and rarely. If you are on dialysis, every drink counts towards your fluid limit.
