Tiffany 00:01
The DNAs podcast series, let’s talk about kidneys. Provides education dedicated to exploring the journey of those living with chronic kidney disease. We’re here to inspire meaningful conversations and to help people living with CKD gain a better understanding of their disease. Today’s let’s talk about kidneys. Podcast topic is pregnancy and kidney disease. What to expect if you have kidney disease and are wanting to start a family, you may have questions or concerns. Dr Cindy corpier joins us today on let’s talk about kidneys to share some helpful insights about how kidney health intersects with pregnancy and family planning. Dr Cindy corpier joined Dallas nephrology over 25 years ago and is board certified in internal medicine and nephrology. She currently provides care for kidney patients at our Dallas North location. She also manages the care of patients with CKD that are either planning to start a family or are pregnant? Welcome to today’s podcast. Let’s talk about kidneys. Dr corpier, how are you? I’m wonderful today. Thank you. We’re so excited to have you join us again. You bring such invaluable site to any topic that we present. But I know that pregnancy and CKD is something that you manage a lot of patients with so we’re going to just jump right into some questions. Okay, great. So Dr corpier, let’s start with the baseline information. What is chronic kidney disease?
Speaker 1 01:32
So chronic kidney disease is an umbrella term, Tiffany, that that means that you have a problem with your kidneys, either the anatomy of the kidneys or the functioning of the kidneys. And everybody’s lumped into that one general, general term of chronic kidney disease. But there are many, many, many conditions that that are covered in all of that. I would when we talk about kidney function, I would just say, just to back up even a little bit more and just say, human beings are biological machines, and that means that we require energy, and we create waste, and we create different kinds of waste in our body every continuously, all day, every day. And so the this is all going to be recognizable to everyone, because we all know we excel carbon dioxide, that that’s one form of waste. We all have a colon, and we know about the solid waste that that’s created there and expelled from our bodies. And we have two other internal organs that are very important in managing the chemical waste, and that’s the liver, and you don’t even know what it’s doing until it’s gone and the kidneys that create urine. What is urine? Urine is sterile water with chemical waste dissolved in it. So what the liver can’t deal with the kidneys are dealing with.
Tiffany 02:54
How can someone with CKD prepare for pregnancy?
Speaker 1 02:59
So there are a few things in no particular order, but a woman who knows that she has chronic kidney disease is most of the time going to be seeing a nephrologist anyway, and has if women of childbearing age, often, we’ve already discussed birth control, for example, and conception and what their plans are and when they decide to move forward with a pregnancy, then there are several things to address the The first is, really well, what is your level of kidney function? And basically, the better kidney function you have, regardless of the disease, the the lower risk you have with pregnancy. Then Then we go to their medications. And there are certain medications that we prescribe to women, to all of our patients, but to but in this case, to women that are for blood pressure control and maybe for their kidney disease, if they have a transplant, if they have lupus, etc. And certain of those medications cannot be given during pregnancy. Some of them, we can get. Some of them, we have to stop months in advance and convert to something else. Some of them, we say, the minute you have a positive pregnancy test, stop this. Let’s let us know, and we change medications. So those are two of the big things.
Tiffany 04:19
Okay, and so you mentioned briefly high blood pressure and the medication that women or anyone that has kidney disease are prescribed. So if a woman has been diagnosed with high blood pressure, how does that affect the kidneys and also the pregnancy?
Speaker 1 04:36
So the just to also, kind of generally talk about hypertension in pregnancy. You have women who who go into pregnancy, who are who have normal blood pressure, and they develop pregnancy related hypertension and new onset hypertension during the pregnancy, and some of those will be easily managed, and their blood pressure goes. Down after the pregnancy, but some percentage of those women will have a worsening and can get a condition called pre eclampsia. Then you have the other group of women who have chronic hypertension. These are women who are already taking blood pressure medications. They know they have high blood pressure, and so going into the pregnancy, that’s when we look at their medications and say every and all their medications, but also specifically here, their blood pressure medicines, and say, okay, which are pregnancy safe there are. There’s an awful lot known about what medications can be safely used during pregnancy. And there are multiple blood pressure medicines that we can use during pregnancy, and there are a few that we absolutely don’t use, and one of the common groups are what are called ACE inhibitors or ARB drugs. Those are medicines like Lisinopril or Ramipril, also Losartan or valsartan Benicar, which is omosartan, medicines like those that we use quite frequently in treating kidney disease, but those absolutely cannot be used in pregnancy.
Tiffany 06:09
Okay, that’s good that you were able to provide the listeners some in some specific examples of those medications that will be discontinued once they are diagnosed with not only with kidney disease, but also become pregnant. And so can you talk about how CKD impacts pregnancy overall? Just kind of paint that picture, because you have people that are watching or listening that have CKD and interested in getting pregnant. So how do those two kind of intersect?
Speaker 1 06:40
Essentially, the better kidney function you have, regardless of the cause that there’s a whatever the problem may be. Let’s say you were born with one kidney, for example. That’s a common congenital anomaly that people, that people are born with one kidney, they may have perfectly fine kidney function. And so somebody in that situation that has normal kidney function, like has 90% or 85% of normal kidney function, they’re relatively low risk for for losing kidney function with a pregnancy. Now, as you go down and women get into the 50% 40% 20% levels of kidney function, the lower their function, the higher the risk that they can lose kidney function, either temporarily or permanently. They’re also at higher risk for for much worsening of their blood pressure, of pre eclampsia and potentially strokes or cardiac heart conditions during the pregnancy. So that’s really the concern, as kidney function goes down,
Tiffany 07:51
and are women with CKD or women who have had a kidney transplant still able to have a healthy pregnancy?
Speaker 1 07:59
Absolutely they they can have a full term pregnancy, because that’s always the goal. That’s where we have to start. A couple of things, though, these women are all considered to be high risk. They’re all considered to be high risk pregnancies and and should be managed by high risk OB and see maternal fetal medicine during their you know, fairly early in their pregnancies. Nevertheless, they can have full term pregnancies and can deliver vaginally. Can deliver by C section, if necessary. And so, yes, they can have a, you know, healthy baby, and they can and they can maintain kidney function, but this has to be managed individually. And so one of the things I say is, or that we know, is, we really need to sort of set expectations for women like this can happen. This can happen. Your blood pressure might go up, and then we’ll do this. The urine protein, which you’re used to following, that might go up, and we’ll manage it this way. If you’re a patient with lupus, we know that lupus can flare, well, how can we prevent that? And what, how do we, how do we manage that going through the pregnancy, and what if you have a flare, and how will we treat it? Or how can it be treated? And I think that it’s very important for for women to know that that all these things I’m talking about can generally be treated, and and, and that they can, you know, have healthy, have their have their pregnancy, and really we are with the OB doctors in the sense we all want healthy mama, healthy baby, full term pregnancy, if we can get there.
Tiffany 09:49
Okay, and so even though it’s a very small percentage here, I still think it’s a good topic to discuss a small percentage of women that are on dialysis. Yes and are of childbearing age, how does that affect pregnancy? I know that can get complicated, but to those that are watching or listening and are part of that percentage, can you discuss how that affects pregnancy?
Speaker 1 10:14
Sure, that is a vastly different situation, and that is much less common than women who have better kidney function, because we know that loss of kidney function impacts fertility, and so fertility goes down in in women who have who have renal failure to the point that they’re on dialysis, and even before that, so but they’re but it’s not 100% necessarily. And so women can get pregnant while they’re on dialysis. If they do the management is very different. They generally people who are on hemodialysis have go for three treatments a week, unless they’re at home. They may do five a week. If you’re pregnant, then we have to intensify dialysis, which means more time, more days of the week, and so generally, we would dialyze six days a week if a woman’s pregnant, to try to get that to the pregnancy, we’re looking to bring their their laboratory tests under far better control, because essentially, what you’re trying to do is have the is have the have the chemical, the chemical makeup in your body to be as close to normal as we can get. It for the growth of the baby and for the maintenance of the placenta, and then we have to be very careful about blood pressure and about fluid. So, yeah, that’s a that is a small number. There’s some data that would that seems to indicate that it’s happening more often. I can honestly say I’ve dealt with it very rarely, because it really is uncommon, but it’s but part of the reason it’s uncommon is because it’s uncommon to have women of childbearing age with kidney failure as well,
Tiffany 12:05
so and so, how do post transplant medications affect a woman that is pregnant or becomes pregnant?
Speaker 1 12:14
So in the transplant situation, it is, it shouldn’t be said to a woman that, oh, you can’t have a baby. That’s really that’s way old news. Okay, we’ve known for a long time that women could carry pregnancies have healthy babies, even though they have a kidney transplant, and what we generally recommend is that they not proceed with pregnancy for the first year or two years. We used to always say two years. Now people tend to say sometimes more one year. And you know, women who are in their 30s, you know, can really feel some strong some great urgency about this, which is understandable if you want to have a family, and so we have to plan for it. And the planning means that we will have to make some generally, we’ll have to make adjustments and medications in advance and give them time to essentially fully eliminate certain medicines from their bodies, because there are medicines that can again, we’re back to the groups of pregnancy safe medicines versus not pregnancy safe medicines. And so we we have to change medicines, and then we have to monitor and make sure the patient is, ideally, as stable, and if their kidney function is stable as a stable as we can get it go. You know everything, they’re not having urinary tract infections, because those can have an impact, an adverse impact, on pregnancy. But yes, they can certainly have have babies. Have had babies, many babies. We love babies, yeah,
Tiffany 14:01
and so are there any other pre existing conditions that will make a difference in a woman’s pregnancy? I know we talked about high blood pressure, so that’s pre existing condition, but any others?
Speaker 1 14:12
Yeah, hyper high blood pressure, hypertension is probably the most common that we deal with. And then there’s some, then there’s some, you know, then diabetes is another one which can certainly haven’t have an impact on pregnancy. Then the one of the ones in the kidney world, specifically, is lupus, systemic lupus erythematosus, or SLE people know about these names, and generally, again, that’s a that’s that’s kind of like a transplant, in the sense that ideally, we’re planning and we’ve got you stable, and you are in remission with your disease and have your medications adjusted before going forward with the. Becoming pregnant. It’s well known that lupus patients can have flares of their disease brought on by pregnancy. Now they their recommendations that they continue certain medicines again to speak to pre eclampsia, which is this very this condition of very severe hypertension that can happen in any pregnant woman, and usually happens later in pregnancy, but that can be prevented by, for example, taking aspirin daily, starting at about 12 weeks. Between 12 and 16 weeks daily, aspirin can help prevent that condition in a Lupus patient or other patient. Specifically in lupus patients, they can continue certain of their medicines. They can continue Plaquenil or hydroxychloroquine, and that’s recommended for them. Some of them have to be on other blood thinners. So they can be very complicated and but again, they too can have, you know, term, or very close to term pregnancies and and maintain kidney function and and have a healthy baby. I mean, we’re not saying they should not have babies, but ideally, again, ideally, you’re in remission, and we can, and we can do all this as safely as possible. Because really, that’s, that’s what we’re trying to do, not trying to ever discourage people from having a family, but just try to make it, you know, safe. Because these moms are, I mean, I mean they’re, they’re, they’re at high risk, so
Tiffany 16:40
And so speaking of moms and you know, following the treatment plans, can you give us some examples, or talk about some patients that you have have had in the past that are pregnant and have had their babies, or, I know you have a couple that are going to be having some at the end of this year. So just give us some of those examples to let the audience know that it’s happening and it’s available for them to start a family.
Speaker 1 17:09
Yeah, one of my patients that I started following very early in my time at DNA, when I worked in Irving, I was a nurse, and she had a condition called IGA nephropathy, and but she had very good kidney function, so I met her when she was single. We went through her, met the boyfriend, married the boyfriend, and then started wanting to have a family. And so we’ve been through it all, and now the older of the two children is in college, and the other one’s getting close to graduating. I have a whole whole bunch of picture Christmas cards in my office of the kids as they’re growing up and have grown up, and I’ve seen them, you know, throughout, she had two healthy babies. Now she did have a change in her urine protein. We did have to adjust blood pressure medicines. I mean, there were some things, but, you know, 20 some years into it, she’s still got normal kidney function. So that’s a very fortunate situation. And she’s got these two healthy kids this year, 2025 I’ve had the unusual situation of having three women who were pregnant. One of them had was in full remission with the disease that she had for some years. And is is I will see next month, and I believe she’s delivered, but I haven’t heard from her, but she had a very ideal situation, good blood pressure, you know, normal urine protein, stable kidney function, that was almost normal. So that was kind of the best picture you could have. Then I have a couple of other ones. I have one who is going to deliver in December, and we’re looking forward to that. So far, she’s done well. Her situation is because people are like, Well, why did you Why do these people have kidney disease? Like these young women have kidney disease? Well, in the case of the of the first two women, I’ve discussed both of them, these are conditions that happen, and we don’t exactly know why, they kind of come out of nowhere. They’re what are called primary kidney diseases, diseases that impact the kidneys and they just show up. And those first two women, this other lady, who’s going to have her baby in December, she has a totally different situation. She was born earlier. I said, part of chronic kidney disease, by definition, is anatomically abnormal kidneys. She was born with abnormal anatomy. This happens sometimes, right, that everything doesn’t develop exactly right, and that’s what happened to her. She developed problems with protein in her urine, and such as a child, and then as an adolescent and etc. And so when it comes to the time where she’s married and now she wants to have a family, she’s got about 50% of normal kidney function and normal blood pressure going into it, she was, her weight was normal, and so she’s having, you know, you know, so far she’s had, you know, we don’t even have her own blood pressure medicine like it’s been and she’s, she’s, she’s having a, having a good pregnancy so far. And we’ll, we’ll, hopefully, you know, healthy baby before Christmas. I have another patient who’s a more complicated patient who is, you know, a young woman of also in her early 30s, who really wants to have a family, and her condition is lupus, and her condition is more complicated and has protein in the urine, and, you know, has a more complex condition, as most women with lupus and pregnancy do so, and she’s not quite as far along, so her due dates a little bit later, but, you know, again, so far, So far so good, and we’re very, very
Tiffany 21:22
helpful for her. All right, so we want to thank you so much, Dr corpier, for your participation today. You certainly have you know, thus, those of us here in the studio, you have enhanced our knowledge, and as far as the viewers, their patients, their families, just getting a better understanding of how kidney disease and pregnancy can kind of intersect, but you just gave some great examples of how it is babies on the way. So thank you again for joining us, and we appreciate your time, and you’re consistently just providing us education. Thanks very much. All right, thank you for joining us today. On let’s talk about kidneys. To learn more, call 214358, 2300, for more information, or to schedule a consultation. Thank you for joining us today. For information about Dallas nephrology associates, please visit our website at d N, E, P, h.com, if you found our information helpful, feel free to share it with others who may also be affected by chronic kidney disease. Dallas nephrology
Speaker 2 22:33
associates DNA podcast series, let’s talk about kidneys is provided for general information purposes only and does not replace the need to talk with a healthcare professional about your unique situation, care and options. Our goal is to provide you with as much information as possible so you can be as informed as possible. Reference to any specific product, service, entity or organization does not constitute an endorsement or recommendation by DNA. The views expressed by guests of their own and their appearance on the program does not imply an endorsement of them or any entity or organization they represent, the views and opinions expressed by DNA employees, contractors or guests are their own and do not necessarily reflect the views of DNA or any of its representatives. Some of the resources identified in the podcast are links to other websites. These other websites may have differing privacy policies from those of DNA. Please be aware that the internet sites available through these links and the material that you may find there are not under the control of DNA. DNA shall have no responsibility for the accuracy, legality or content of the external site or subsequent links. Contact the external site for answers to questions regarding its content. The resources included or referenced in the podcast and on the website are provided simply as a service. DNA does not recommend, approve or endorse any of the content on the link sites. The content provided on this website and in the podcast is not medical advice and should not be used to evaluate, diagnose, treat or correct any medical condition. The content is solely intended to educate users regarding chronic kidney disease, end stage renal disease, ESRD, end stage kidney disease, ESKD, and related conditions and ESRD, ESKD treatment options. None of the information provided on this website or reference in the podcast is substitute for contacting a healthcare professional. The.