I met Ms. C when she was pregnant at 15 weeks gestation. She was referred for proteinuria, hematuria, and abnormal kidney function. Over the course of the next few weeks, we weighed the pros and cons of a kidney biopsy, home vs. in-center dialysis, genetic testing, and more. I spoke with multiple physicians, including nephrologists and obstetricians featured in this section, for guidance and reassurance. As her pregnancy progressed, and her kidney function worsened, Ms. C, her team, and I used shared decision-making to decide to start her on home hemodialysis, which would ultimately allow her to dialyze at her rural home while her child recovered in the neonatal intensive care unit. There was an anxious moment as her home-training nurse started the machine, but Ms. C did great. She completed her training in a record timeframe—under 4 weeks. When her blood pressure began to rise at the end of treatment, we collectively agreed it would be best to admit her for the remainder of her pregnancy. While her husband was several hours away, she went into labor overnight. I headed to the hospital and had the ultimate privilege of being with her as she labored. After her son was born, we talked through the challenges of breastfeeding, and I reached out to lactation experts to learn more than what I knew from my own experiences. Through a team of experts and caring physicians, Ms. C has thrived as a patient receiving home hemodialysis, and her son has grown and exceeded all expectations.
Having children is important to many of our patients and with the advancements in reproductive assistive therapies and the younger age at which patients are affected by kidney diseases, we will continue to see more opportunities to assist our patients with having the families they desire in the healthiest and safest way possible. Taking care of these patients is an incredible, sometimes harrowing experience. Pregnancy in women with chronic and end stage kidney disease has been a keen interest of mine. However, despite my reading, research, and prior experiences, I had to call upon a team of experts to provide my patient with the best care. My hope is that this special section in this issue of ASN Kidney News will provide nephrologists with a window into the awe-inspiring and transformative experience of providing care for these women and their children and will be a resource of both knowledge and encouragement for those facing these challenges with their own patients.