Renal transplantation and pregnancy.

INTRODUCTION: Although pregnancy after kidney transplantation is feasible, complications are relatively common and this needs to be considered in patient counseling and clinical decision making. REVIEW: Fertility generally returns after renal transplantation. Approximately 74% of pregnancies in kidney transplant recipients end successfully in life births. Published reports suggest that pregnancy has no adverse affects on graft survival although patients with higher pre-pregnancy serum creatinine have a trend toward increased post-pregnancy serum creatinine. There is, however, a significantly increased risk of preeclampsia, gestational diabetes, cesarean section and preterm delivery compared to the general population. Almost half life births are preterm, and low birth weight is very common. Immunosuppressive medications are required to be continued during pregnancy in transplant recipients to prevent graft rejection, except for sirolimus and mycophenolate mofetil (MMF) which are contraindicated during pregnancy. The incidence of birth defects in the live born is similar to the general population, except for pregnancies exposed to MMF which have a high incidence of birth defects. Every female in the reproductive age group should be counseled regarding pregnancy including the potential risks to the graft, to the mother and to the child. Timing pregnancy should be based upon whether graft function is optimal, but the general recommendation is to wait one year post transplantation before conception. CONCLUSION: Pregnancy in renal transplant patients should be planned with combined care from surgeons, nephrologists, obstetricians, pediatricians and dietitians which offers the best chance of a favorable outcome in the mother and the fetus.

Renal replacement therapy in Nepal.

Renal replacement therapy in Nepal fulfills only a small part of the current needs, with 97 hemodialysis machines available for the general population of 29 million. Transportation difficulties to dialysis centers preclude many of the patients from end-stage renal disease care, due to the rural nature of the population. Peritoneal dialysis (PD) organized into rural sub segments, considering the Mexican model of PD and government funding appear to offer some solution to provision of care for this mountainous rural country. We review the current statistics of dialysis patients, hemodialysis numbers, and renal transplantations within Nepal and offer suggestions regarding possibilities for increasing renal care within the country.