Childbirth is a very difficult process for the mother's body, so there is an opinion that if there is a serious congenital painful condition, then it is almost impossible to give birth to a normal baby.
In some cases, this is not the case, because with proper pregnancy planning, the unborn child will not have developmental delays. This includes pregnancy with one kidney.
WARNING! The information on the site is provided for informational purposes and cannot be used to make a diagnosis or make treatment decisions.
Definition and causes of “single kidney”
This happens if the organ is removed as a result of surgery (nephrectomy), or it was not initially present at birth (agenesis), or if there is a single transplanted kidney.
There are a number of diseases as a result of which kidney functions become less active, to the point that one of them may fail:
- mechanical injury;
- pyelonephritis;
- urolithiasis (in the chronic stage) disease;
- hydronephrosis;
- cyst;
- hypertension;
- organ tuberculosis;
- malignant tumor.
A more complex case is congenital renal aplasia.
In most cases of such an anomaly during pregnancy, the only kidney may not perform its functions fully.
When one kidney is underdeveloped, congenital defects in the structure of the urinary tract and uterus are present. This combination can lead to the constant occurrence of pyelonephritis and difficulties in the process of bearing a child.
Can a woman give birth with one kidney?
Yes, it can, but it requires constant examination by doctors and several special individual procedures.
A woman’s body is able to cope with the load on the excretory system even if there is only one kidney. Careful management of pregnancy can prevent the occurrence of a number of characteristic complications.
Kidney function during pregnancy
The kidney is the main organ in the human urinary system.
WARNING! The information on the site is provided for informational purposes and cannot be used to make a diagnosis or make treatment decisions. The body has 2 kidneys. Located on both sides of the spine. One is slightly higher than the other.
The shape of the organ is described as bean-shaped. Hidden inside it is a complex system for filtering blood from unnecessary salts, waste products and harmful substances.
Proper kidney function helps remove excess fluid from the body.
During pregnancy, the load on the entire excretory system and the kidneys in particular increases significantly. Much more blood needs to be filtered than before pregnancy.
As a result of this, the lumens of the renal pelvis expand, the ureters enlarge and their shape changes.
These modifications are aimed at increasing the permeability of blood through the channels of the urinary system.
In addition to purifying the blood, the kidneys also perform the following functions:
- vitamin D production;
- hormonal (production of hormones by the adrenal glands);
- regulation of osmotic processes in the cell by controlling the content of potassium and sodium ions in body fluids.
Planning pregnancy after kidney removal
Before becoming pregnant after nephrectomy, it is necessary to conduct a complete examination of the woman in a hospital setting.
The results of successful conception, healthy pregnancy and natural childbirth will be influenced by the following factors:
- weight of the expectant mother;
- her age;
- cause of kidney loss;
- nature of concomitant diseases.
It is worth noting that if an organ fails as a result of an illness, then it is first necessary to undergo an appropriate course of treatment until complete recovery. Therefore, it is not recommended to plan a child after:
- Tuberculosis, when antibiotic therapy was stopped less than six months ago, or is still ongoing.
- Oncological tumor, since there is a possibility of recurrence of health problems in the second kidney. During pregnancy, this can lead to fetal loss and even death for the mother.
- Pyelonephritis.
- Hyper- or hypotension.
In some cases, if you ignore the instructions of your doctor, pregnancy with one kidney can lead to the development of:
- chronic renal failure;
- arterial hypertension in acute form;
- stroke;
- hypoxia, fetal infection;
- developmental defects of the baby.
As a result, this leads to premature rupture of the amniotic sac, premature birth, miscarriage, or even the death of the mother. The specialist who will manage such a pathological pregnancy calculates all possible risks and complications that may arise during pregnancy and childbirth.
To do this, the woman undergoes all prescribed tests and studies. The doctor calculates the risks for each possible disease. Only after this is a medical verdict made about the possibility and prohibition of conception.
Is it possible to get pregnant with one kidney?
Conception is not excluded and is recommended by the attending physician if the only kidney can cope with the increased load and does not have a serious effect on the reproductive system.
The most favorable period for conception in women occurs 2 years after nephrectomy.
– When and how did you first come across the topic of pregnancy after a kidney transplant?
– At the end of the 80s, transplantation in Russia was just beginning to appear. Only a few dialysis centers operated throughout the country, but the number of patients numbered in the thousands. In such conditions, transplant operations were performed not simply to develop the field, but also to free up space for new patients. There was no talk of pregnancy then. But it so happened that the first cases occurred precisely at that time. In just a year and a half, several women announced that they were expecting a baby. The first time like this was a shock for us. The patient became pregnant and wanted to give birth - despite the doctors’ prohibitions. At that time there was neither the Internet nor access to foreign literature. The clinics were afraid to take her under observation, since no one had the relevant experience. I was also afraid - I didn’t know how immunosuppression would affect the course of pregnancy and the fetus. But I really wanted to help and support. I wanted the child to survive and see the light. I started calling maternity hospitals - they didn’t even want to talk to me.
How did you manage to get pregnant?
– The only ones who responded to my cry were academicians Valery Ivanovich Shumakov and Vladimir Ivanovich Kulakov. Today, the National Medical Research Center for Transplantology and Artificial Organs and the Scientific Center for Obstetrics, Gynecology and Perinatology are named in their honor. At that time they were ordinary professors. That first time I came to the head of the Institute of Transplantology, Valery Ivanovich, and he sent the patient and me to the institute to Kulakov. The doctors looked at us and did not understand at all what they were facing, but they decided to help. We agreed to give birth at the Institute of Transplantology - after all, we did not know what could happen to the kidney, how it would behave. Neonatologists, resuscitators, and transplantologists were present. And now a healthy baby was born! The entire institute gathered to escort him to the neonatal center - everyone gave a standing ovation. So much time has passed, but I remember it like it was yesterday. These memories bring tears to my eyes. Then it was difficult for us to imagine even one such pregnancy, but in a short time several more children were born. And here I must emphasize that over these 30 years, a huge number of women have become mothers not once, but even three times. And with a transplanted heart, and liver, and pancreas. And all this is thanks to these two great people - Shumakov and Kulakov: they were the ones who stood at the origins.
– Do you need special preparation for pregnancy after transplantation?
– There must be preparation. All transplant patients take immunosuppressants - these drugs prevent the donor organ from being rejected. Those first pregnancies ended well because we used less toxic immunotherapy in the 1980s. But new generation drugs, on the contrary, are dangerous for the fetus. Therefore, before the patient becomes pregnant, they must be changed. This minimizes the risk of developing anomalies incompatible with life.
There is another point: without proper attention, alternative immunosuppressants can harm the functioning of the donor kidney. Therefore, very careful preparation and monitoring of the woman’s condition is needed. In such a situation, the doctor is responsible for three people: mother, child and organ. I am categorically against making independent decisions regarding pregnancy after transplantation. Now patients have become bolder, they communicate on forums and learn information through word of mouth. But if you act without consulting a doctor, it is very easy to cause harm. I want to urge both women and doctors: let's take pregnancy seriously, because there is no spare kidney in the refrigerator.
– What period of pregnancy is considered the most difficult?
– The first two trimesters flow magically: both patients and doctors relax. My experience is that doing this is dangerous. After all, the most difficult period begins at the end of the second trimester - you need to be on guard, carefully monitor health indicators and tests, changes in well-being. Therefore, pregnancy in women with a transplanted kidney should be managed not only by high-risk obstetricians-gynecologists, but also by transplantologists, neonatologists, and geneticists. Almost all of these women are predisposed to the formation of so-called gestosis - nephropathy in the second half of pregnancy, to dystrophic changes in the liver. It happened that within a few hours the patient’s organ could fail. You never know how a woman’s body will behave after an organ transplant, even if she has an ideal pregnancy. Therefore, being under the supervision of specialists at this time is very important.
– How does the body behave after childbirth?
– Carrying a child to term and giving birth is only 50% of success. The hard part comes after. When a woman gives birth, overall hormonal levels come to a sudden halt. In the case of a caesarean section, the jump generally occurs within 20 minutes, and this is already a prerequisite for the kidney to fail. We have worked out the scheme. During childbirth, we administer increased doses of hormones to prevent hypothetically possible rejection and deterioration of the function of the donor organ. But still, after giving birth, the patient should not leave the field of view of the nephrologist, obstetrician-gynecologist, and my own. At this time, for such women everything is just beginning.
– What are the contraindications to pregnancy for women after transplantation?
– The main contraindication is poor graft function. I want to say again: sometimes the desire to become a mother prevails over fear. And women go for it. Sometimes it’s possible to convince them: “You’ll still have a second transplant in a year, so let’s wait.”
– How do you encourage your patients to perceive difficulties positively?
– I have an amazing stand that has been running for many years. This is a tree with golden apples, where I enter every new child and his mother. And every year there are more and more names: someone gave birth again, someone for the first time, someone for the third time. Before transplantation, patients have gloomy thoughts - either getting on the waiting list, or writing a will and calling it a day, finishing some things in life. And suddenly the patient sees a tree with golden apples, and she has a desire to live, to fight. The person switches instantly.
– What is the most important thing in pregnancy management?
– It is important that after transplantation or childbirth the patient lives, and does not just go down in the statistics as the 2005th person who gave birth. A woman should be healthy, close to her child, and be there as he grows up. A child needs a healthy, living mother, at a minimum. I don’t understand “sport” in medicine when they say: “Let’s do 300 transplants and report to the state.” How many of these people will survive and live happily ever after? It's the same with pregnancy. In almost 30 years of work, I have had about 300 patients who gave birth after a transplant. Some have had several pregnancies, while others have already had children of their own. There is a woman who gave birth to three, and two are especially not uncommon. I can say with joy and pride that during all this time, not a single woman has lost a transplant during pregnancy. In no one did pregnancy affect the function of the transplanted organ. This is a great victory.
– What kind of development would you like?
– It is necessary to take the birth itself outside of Moscow. In this matter, educational work is necessary: giving lectures, collaborating with hospitals online. I managed more than one pregnancy this way; there were even cases of “Skype childbirth.” In the regions, unfortunately, there is still an opinion that women after transplantation are contraindicated to give birth. For this reason, doctors often call for termination of pregnancy, and patients are forced to come to Moscow for support. We, doctors, do not have the right to decide for a woman whether she should give birth or not, or to drive her into a frenzy by calling for an abortion. We can only say about the degree of risk. If she goes for it, I say: “It’s your decision, but I can promise you that I will be there for 9 months, 24 hours a day.”
– What is work for you?
– I still keep each patient’s cards. I have a whole archive, and it is not in the form of history on the Internet, but handwritten. When you write, you experience everything again. There is an elusive psychological aspect to this; I like to fill these stories with my hand. I have been a transplant for 33 years - my whole life, during which time I have had periods of disappointment, depression, troubles, like any other person. And exactly at 8 am, when I come to work, I recover from my problems. Young, rich, poor - it doesn’t matter, it would seem that there is a whole life ahead. My problems are nonsense. Thanks to today's level of medical development, these patients already have a future. And they can live a long life, and we will help them with this.
Author: Victoria Cheremushkina
Features of pregnancy with one kidney
The main function of the organ is excretory, that is, women with serious problems in the functioning of the genitourinary system are at risk.
The result of kidney failure is its inflammation, which can be determined by the presence of an increased level of protein in the urine in the test results.
There is also a possibility of infection of the excretory tract, which significantly complicates the course of pregnancy. Complications in the functioning of a solitary kidney may lead to the need for a cesarean section.
One of the main causes of complications is non-compliance with the prescribed diet. In the process of planning and carrying a pregnancy, it is necessary to monitor
In the process of planning and carrying a pregnancy, it is necessary to monitor other kidney functions:
- Endocrine (regulating water balance in the body).
- Ion-regulating (helping to control alkaline environments in the human body and balancing the amount of hydrogen and bicarbonate ions).
- Metabolic, which is directly related to the transport function of proteins, carbohydrates and fats in the body.
At the stage of pregnancy planning, it is necessary to undergo all studies and strictly follow the instructions and recommendations of specialists.
Childbirth with one kidney
The presence of a single kidney is a direct indication for cesarean section. Natural childbirth takes place only on the basis of absolutely normal test results.
It is necessary to go to the operation in advance, undergo the necessary examinations and prepare properly.
The woman in labor is closely monitored throughout the operation.
Possible complications during pregnancy
The likelihood of complications occurring during pregnancy depends on the reasons for which the kidney was removed.
- if a kidney is removed due to pyelonephritis, then during pregnancy the risk of developing this disease again arises;
- if the reason for removal was tuberculosis, then the likelihood of recurrence of the disease during pregnancy is high;
- after removal of a kidney due to hydronephrosis, a high percentage of favorable pregnancy and the natural process of childbirth;
- polycystic kidney disease also often causes the removal of one of them. In this case, the chances of a successful pregnancy are 60%, because there is still a possibility of cysts occurring on the second kidney;
- a previous oncological process in one of the kidneys is a direct indication to postpone pregnancy.
Along with these complications, kidney function disorders such as:
- inflammatory process in the kidneys - pyelonephritis;
- gestosis or late toxicosis, which has an extremely negative effect on the child’s condition;
- secondary tuberculosis of the kidney.
Possible complications after childbirth
After giving birth, a woman with one kidney may experience the following complications:
- Pyelonephritis. It worsens when the disease is latent in the remaining organ.
- Hydronephrosis. In this case, the renal pelvis expands in size, and renal failure occurs.
- Kidney tuberculosis. The disease can develop if this diagnosis was the indication for nephrectomy. If the disease is detected, anti-tuberculosis therapy is carried out.
- Arterial hyper- or hypotension.
The consequences of nephrectomy due to cancer can be different. Postpartum testing is necessary to determine the likelihood of recurrence and damage to the remaining organ.
Diagnosis of complications
Diagnosis during pregnancy requires additional studies and tests. Monitoring the functioning of the urinary system comes down to determining the current functional state and capabilities of the preserved organ. For this purpose, the following methods are used:
- Ultrasound of the kidneys -
ultrasound allows you to visualize the renal parenchyma and determine the current state of individual structural elements. - Thermography (thermal imaging) of the lumbar region is
a study based on the determination of infrared thermal radiation from kidney tissue. The visual series allows a pregnant woman to safely and painlessly identify inflammatory processes and other functional disorders in the functioning of the organ. - General urine test -
this laboratory test becomes the leading indicator of the condition of the urinary system of a woman carrying a child. In the absence of a history of kidney disease, a general urinalysis is done more often to promptly identify any possible abnormalities. - Biochemical blood test -
a comprehensive urine test using this method is aimed at an objective assessment of the filtering capacity of the remaining kidney.
An additional study of blood vessels (phlebography) can also tell the doctor a lot about the state of the expectant mother’s urinary system.
Contraindications
There are a number of absolute contraindications for pregnancy and childbirth in women with one kidney. In such situations, in almost 90% of cases, not only the baby suffers, but also the mother herself. There is a high probability of death not only for the fetus, but also for its mother.
Among these restrictions:
- transplanted organs (lifelong therapy negatively affects the development of the child, and its cancellation affects the health and life of the woman);
- serious and extensive abnormalities of the internal genital organs;
- urolithiasis in the chronic stage;
- glomerulonephritis and sluggish chronic pyelonephritis;
- damage to the remaining kidney by tuberculosis, oncology, hydronephrosis.
How does pregnancy affect kidney disease?
During pregnancy, exacerbations of chronic pyelonephritis, glomerulonephritis, and urolithiasis may occur. An exacerbation can occur already in the early stages of pregnancy, most often at 15-16 weeks. If you experience lower back pain, swelling in your arms and legs, there is a retention and decrease in the amount of urine produced, or pain during urination, consult your doctor immediately. In such cases, urgent hospitalization is necessary.
However, most often, exacerbation occurs between 26 and 30 weeks, when the rapidly growing uterus begins to put pressure on the ureters. As a result, the outflow of urine is disrupted and infection in the kidneys is activated.
Indications for natural childbirth
Natural childbirth can only be carried out if obstetricians have complete confidence in a successful outcome. They can talk about this:
- The mother’s condition is satisfactory, namely: normal functioning of the excretory system, excellent health, lack of stress.
- Positive ultrasound results.
- No problems with the uterus, reproductive and urinary tract.
- Absence of viral and bacterial diseases.
Indications for emergency caesarean section
The operation is prescribed in cases of diagnosing:
- acute pathologies of the uterus and disorders in the mother-placenta-fetus system;
- sudden and aggravated poor health of the mother due to insufficient metabolism;
- protracted labor, when cervical spasm occurs or labor ceases despite stimulation;
- hypoxia in the fetus;
- embryo rejection.
Recovery period after childbirth
In the postpartum period, it is very important for a young mother to monitor her health and follow all the recommendations of the observing specialist.
An important point is timely monitoring of the functioning of the only kidney.
In order to recover quickly and without harm to your health after childbirth or a caesarean section, you must strictly follow a number of rules.
One kidney is not a death sentence for a woman who wants to get pregnant and give birth to a healthy baby. When planning, as well as throughout the entire gestation period, it is necessary:
- constantly monitor your own well-being;
- notify the leading gynecologist about all changes in your own health;
- undergo scheduled examinations on time;
- strictly follow medical recommendations;
- follow a daily routine and nutritional rules;
- avoid stressful situations;
- lead a healthy lifestyle.
With a responsible and competent approach to pregnancy and childbirth, the unborn child will not have developmental delays. Women with one kidney may well give birth to a completely healthy baby.
Author: Maxim Dmitrievich, obstetrician-gynecologist Specially for the site kakrodit.ru
Causes of pathology in pregnant women
A healthy woman's body should have 2 kidneys. In some cases, it happens that only one remains.
Such a pathology in the body can be:
- congenital;
- acquired.
Congenital pathology occurs when a woman was born with one kidney. This condition is called aplasia.
This occurs due to the fact that in embryonic development, under the influence of some factor, there is a failure in the formation of the main organs.
Usually one kidney does not develop. But in rare cases, both kidneys may not form at once. In this case, the child does not survive.
Sometimes congenital one kidney is not diagnosed immediately. After a while, certain problems arise.
It may happen that until pregnancy occurs, a woman may not even know about her pathology.
It is worth talking about the acquired form of pathology in cases where one kidney was surgically removed.
This need may arise in severe cases of diseases such as:
- pyelonephritis;
- kidney tuberculosis;
- oncological kidney tumors;
- mechanical injuries;
- hydronephrosis.
In this case, the pathology is called nephrectomy.
