In terms of general anaesthetic management, the problems of pre-existing renal disease are the same as in the non-pregnant population. These include the underlying cause of renal impairment, systemic manifestations of renal failure (in particular, hypertension and ischaemic heart disease, thrombocytopenia and anaemia), the patient's medication, altered handling of drugs and fluid management, including the nature and timing of dialysis.
Obstetric management may be influenced by the above factors and any history of previous abdominal surgery, including the presence of a transplanted kidney. There is an increased risk of pre-eclampsia in mothers with renal impairment. The fetus may be at risk from the underlying disease that caused renal impairment or from the above complications.
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