Abstract

Pregnancy with a single kidney has been primarily evaluated using data from kidney donors. However, in general antenatal clinics, women attend with a single kidney for many other reasons and therefore the outcomes of these pregnancies cannot be predicted based on post donation data.

A series of 11 women was identified who entered pregnancy with a single kidney. The reasons varied from congenital absence to renal disease. In this cohort there was a striking lack of awareness of the possible long term consequences of a single kidney and the importance of its optimal care during and after pregnancy amongst both the patients and the obstetric staff. There was a widespread lack of prepregnancy counselling, any regular surveillance in primary care and an unawareness of the importance of maintaining the health of remaining renal tissue.

Management plans and counselling varied considerably, reflecting the lack of clear guidance for the care of patients with a single kidney, before during and after pregnancy. Potentially avoidable compromise of renal function is also identified, which will inevitably impact on future renal and therefore general health.

We propose a model for coordinated prepregnancy care of women with a single kidney, vigilant monitoring and prompt treatment of complications during pregnancy. It emphasises the unique opportunity we have during pregnancy to educate and engage women and clinicians about the importance of robust care of the remaining kidney and lifelong annual surveillance thereafter to ensure optimal longevity of remaining renal tissue and general health.