Pregnancy and Renal Failure

Abstract

Pregnancies in women with renal disease, undergoing dialysis treatment or with kidney transplants are increasingly observed. Serious problems with drug dose adjustment may arise in pregnant women with renal impairment. This review gives a practical overview on the risks of drug use during gestation, the recommended drugs of choice (e.g. methyldopa, cyclosporin), and provides some proposals for dosage adjustments in pregnant women with renal impairment. In normal pregnancy, the glomerular filtration rate and plasma volume increase, whereas plasma protein binding and liver function may be impaired. An increase in dosage is needed for cyclosporin and for methadone because of increased hepatic clearance. The dosage of erythropoetin must be increased because of lower potency in pregnant women. Little more is known on the impact of gestation on drug dose, since pharmacokinetic studies are rarely done in pregnant women. The dosages of magnesium, lithium and morphine must be reduced in renal impairment. Dose adjustment to renal function is critical and is essential for anti-infective agents (e.g. ceftazidime, ganciclovir). Basing drug dose on estimated creatinine clearance might be the most practical solution in pregnant women with renal impairment.

Disposition of Chiral and Racemic Fluoxetine and Norfluoxetine Across Childbearing

“…15 Other changes in pregnancy may increase drug clearance; the expanded plasma volume and total body water augment the volume of distribution of drugs. Altered hepatic perfusion (increased portal venous return and unchanged hepatic arterial blood flow), 16 reduced plasma protein (albumin) levels that lead to decreased drug binding, increased glomerular filtration and renal excretion 17,18 may give rise to increased dose requirements. These changes may explain the intraindividual variability in treatment response during the childbearing period.…”