Pregnancy outcome in women with reflux nephropathy and the inheritance of vesico‐ureteric reflux

In women with reflux nephropathy, we investigated whether pre‐existing hypertension and impaired renal function influence the rates of preeclampsia, renal function deterioration and preterm birth. The infants were investigated for vesico‐ureteric reflux (VUR). A prospective audit of 54 pregnancies in 46 women with reflux nephropathy was performed. Preeclampsia complicated 24% of pregnancies and was increased in women with pre‐existing hypertension (42%) compared with normotensive women (14%), (RR 3.0 (95% CI 1.1–7.8)). Nine (18%) women experienced deterioration in renal function during pregnancy. Women with mild or moderate renal impairment were at increased risk of renal function deterioration (RR 12.7 (95% CI 1.6–98.5); RR 19.8 (95% CI 2.6–155)), respectively. A third of infants were delivered preterm. The risk of preterm birth was increased if the mother had pre‐existing hypertension (p = 0.01) or moderate renal impairment (p = 0.002). Seventeen (43%) of the 40 infants who underwent micturating cystourethrography had VUR, consistent with autosomal dominant inheritance with reduced penetrance. In reflux nephropathy, pre‐existing hypertension was associated with an increased risk of preeclampsia and pre‐existing renal impairment with deterioration in renal function. Infants of women with reflux nephropathy should be screened for VUR.