Pregnancy does not exacerbate primary glomerular disease.

Recent studies of relatively large numbers of gravidas with primary renal disease indicate that pregnancy probably does not affect the underlying disease in the absence of overt renal insufficiency or hypertension. Women with renal disease and near normal function have a moderate risk for encountering a rise in blood pressure and decline in renal function during pregnancy, complications that are usually manageable and reversible after delivery. There is a substantial risk, however, that heavy proteinuria and edema formation may occur toward the latter stages of pregnancy, especially in women with preexisting proteinuria, although this complication also usually reverses after delivery and does not affect the underlying renal disease. The question of the effect of pregnancy on renal disease in women with moderate renal insufficiency at the start of pregnancy is unanswerable on the basis of available data. Published reports indicate that severe hypertension is a major complicating factor during pregnancy in many of these women and, on theoretical grounds, may play an important role in aggravating the renal lesion. To resolve this question, studies are required in which prepregnancy levels of GFR are carefully monitored, a specific diagnosis of the underlying renal disease is established, and elevated blood pressure levels are normalized during pregnancy.