Our kidneys are failing but we want to be mums

There is a worrying rise in the number of younger women getting kidney disease, the country's top renal doctors have warned.

Getting pregnant when you have sick kidneys, they say, is difficult; and when it happens, it comes with life-threatening complications, especially if the mother is on dialysis.

“Pregnancy in women with chronic kidney disease (CKD) poses risks to mother and child, so women need to be informed about these, and termination of pregnancy discussed if appropriate,” says the team.

In a report, doctors Samuel Kabinga, Jackline Otieno, John Ngige and Seth Mcligeyo share the stories of two patients at Kenyatta National Hospital who battled failing kidneys to fulfil their desire to have babies.

The first woman presented with kidney problems just over a decade ago when she was 21.

She was put on a cocktail of medications, and was in and out of hospital in the years that followed.

Around 2016 when she was 28, she expressed a desire to conceive. She was advised on the risks and benefits of conception at the time, and the need for regular medical reviews, the team wrote last month in the journal Obstetric Medicine.

Two years later, she had presented at the KNH renal clinic with a six-month pregnancy. She had uncontrolled blood pressure, headache, body swelling, and other symptoms consistent with kidney disease.

She was put on medication to control blood pressure while labour was induced immediately but unfortunately, she lost the baby.

After the ordeal, the doctors say her health improved significantly and she was advised on future conception and put on follow-up renal and postnatal clinics.

“She conceived again the following year, and she presented at two months of gestation and was followed up in the high risk antenatal clinic.”

She was put on a regular cocktail of medications and remained on close medical observation. She was admitted at week 34 of the pregnancy when some complications were observed.

She had developed high blood pressure and poor kidney performance with the hospital observing reduced foetal movement. “She underwent an emergency caesarean section and delivered a live male infant.”

Her health after birth the doctors say had deteriorated and she was put on emergency dialysis. After several sessions, she stabilised and was discharged to continue with dialysis as an outpatient.

“On the last review, she was stable with well-controlled blood pressure and was on twice-weekly dialysis as an outpatient. She was breastfeeding and able to take care of herself and her baby,” the doctors say of the success.

Older mother

The second case was different in several ways but not any less dramatic with the woman being older and with previous births.

The woman was 43-years-old and had had three previous pregnancies when she was referred to the KNH renal clinic. 

She had a 30-week pregnancy and referred from a rural clinic where she had been followed up for high blood pressure and kidney disease.

Two of her three previous pregnancies had not ended well while the first at age 21 had yielded a full-term live male infant. The second pregnancy, when she was age 30 ended in a miscarriage at 20 weeks but tried again when she was 40.

This third pregnancy was delivered by emergency caesarean at 28 weeks but the infant died from complications of early birth.

In the latest fourth attempt at pregnancy the woman reported at the clinic with symptoms of sick kidneys, lower abdominal pains, vomiting, and headache and reduced foetal movements.

She was put on a cocktail of medication, emergency dialysis and blood transfusion for suspected anaemia.

An emergency Caesarean section was performed due to concerns about foetal well-being and a live male infant was delivered and admitted to the newborn unit.

“On the last review, the mother was stable, on dialysis and the baby was doing well,” the doctors tell of another success story.

But it is not just about the two women with data suggesting women suffering kidney disease are six times likely to get a stillbirth compared to those in the general population.

A 2019 study among 2,068 maternity admissions at KNH reported the highest rates of stillbirths to occur among women with kidney disease.

Led by Dr Jayne Mueni Kivai, the study found almost a third of women with kidney disease to have lost the babies.

In the study which appeared in the IOSR Journal of Dental and Medical Sciences of the 66 women who had kidney disease, most were relatively young, aged about 28 years.

Dr Kivai and colleagues suggested the increasing pregnancy-related acute kidney injury may be related to a rise in lifestyle disease including diabetes and hypertension.

This, the four doctors who attended to the two women and all linked to KNH, East African Kidney Institute, and the University of Nairobi, say is a major challenge in managing maternal health.

“With a growing population of women of reproductive age with kidney disease in our setting, methods of supporting their reproductive lives should be developed.”

Already a Sh 2.5 billion complex to house the East African Kidney Institute is being constructed at KNH grounds expected to house modern kidney research and treatment facilities.

The increasing kidney disease among younger women who desire to have children the team suggests is one of the complex issues the new institute will be addressing.

The second, they say is to train enough specialists and support staff to manage increasing kidney disease in the country.

The experts explain it is difficult for women to conceive while suffering from kidney disease because the condition is known to reduce fertility even in women of prime reproductive age.

But if pregnancy happens, it is associated with more complications and worse outcomes for both mother and infant compared to other women.

Such women are at higher risk of high blood pressure, preterm delivery, loss of maternal renal function, and increased possibility of caesarean deliveries.