Everything You Need To Know About Women and Kidney Disease

The kidney is an important organ responsible for many functions in the body including removal of waste and toxins from the food and chemicals we expose ourselves to, removal of acid from the body, regulation of blood pressure and the regulation of substances necessary for production of blood and bone.

The kidneys perform these functions every minute, 24 hours a day, year after year and when we loose up to 80% of kidney functions, we begin to have symptoms of kidney disease such as weakness, nausea, vomiting, itching skin, difficulty breathing, chest pain, leg and eye swelling and loss of appetite. At this stage of kidney disease, it is important to see a kidney specialist to possibly recommend the start of kidney replacement therapy in the form of dialysis or kidney transplantation.

It is estimated that approximately 13% (~20million) of Nigerians have some stage of kidney disease and several thousands have lost so much of their kidney function that they are in need of kidney replacement therapy in the form of dialysis or kidney transplantation.

In Nigeria, the peak occurrence of chronic kidney disease is between the ages of 20 and 40, thus contributing to manpower shortage and economic waste. In a study by Ulasi and Ijoma highlighting the enormity of kidney disease in Nigeria with the situation in a Teaching Hospital in the southeast of Nigeria as a reference, end stage kidney disease cases requiring dialysis accounted for 8% of all medical admissions and 42% of renal admissions.

While the most common causes of kidney disease in Nigeria are hypertension and diabetes, a number of cases of kidney disease occur uniquely in women such as kidney disease that occurs or worsens during pregnancy; or occurs more frequently in women such as kidney disease due to a disease of the immune system called lupus.

Despite abundant evidence to support observations that women are key decision makers in the family when it comes to healthcare, there appear to be differences in health outcome between men and women with kidney disease. While evidence is not currently available in Nigeria, there is reason to believe that the longevity women have over men in the general population without kidney disease disappears in the presence of kidney disease.

Accelerated disease patterns, less access to health care and less funding for care of women with kidney disease compared to men are some of the speculated causes for this observation. For example, in the United States, from 2000 to 2007, the percentage of dialysis patients who were registered on a waiting list for transplantation increased from 15% to 17%. In all those years, females were less likely than males to be registered on a waiting list.

The keys to identifying, preventing or controlling progression of kidney disease include:

1. Having regular check ups with your doctor (at least annually) to check your weight, blood pressure, blood sugar and kidney function
2. Regular sufficient exercise
3. Healthy low salt diet
4. Weight control
5. Avoiding smoking and minimizing use of alcohol
6. Taking medications as prescribed by your doctor

There are multiple issues peculiar to the daily lives of women of all ages that have kidney disease that are important to know.

Menstrual Periods and Kidney Disease

In the early stages of chronic kidney disease menstrual periods become irregular. Once kidney function falls below 20%, menstrual periods may even stop altogether. At this stage, a woman is less likely to conceive because of the accumulation of waste and toxins in the blood and poor ovary function and egg production.

The ability to conceive is poor even with dialysis because dialysis doesn’t perform all of the tasks of the natural kidneys. A drug given during dialysis called erythropoietin can help some patients regain their periods event while on dialysis. Erythropoietin is produced by the kidney and in kidney failure, this has to be given by injection. Kidney transplantation however restores ovarian function, egg production and ability to get pregnant.

Sexuality and Kidney Disease

Many people including women loose their desire for sexual activity when they have kidney disease. There are emotional, physical and psychological factors at play that can diminish the sex drive. Getting used to life with a chronic illness and the lifestyle changes that come with it takes time. There can also be stresses related to job, income and family life that a woman will have to adjust to.

Emotional causes such as fear, anxiety and depression can seriously affect men and women equally and interfere with sexual intercourse, the ability to conceive or ability to carry a pregnancy to term. Healthy eating, exercise, talking to your partner about sexuality and health in an honest open way and following the doctors instructions are one of many ways to help deal with the emotional stress.

For most patients, sexuality improves with the initiation of high quality frequent dialysis and gets even better after kidney transplant. Sometimes there may still be problems with sexual drive that persist even after transplant related to use of medications to prevent rejection or treat high blood pressure.

Physically, lower hormone levels may cause some women to experience vaginal dryness or painful intercourse. A water-soluble vaginal lubricant can be used to remedy these situations. Side effects of certain medicines and complications from toxin accumulation can cause fatigue, menstrual irregularities and decreased sexual desire.

Some medications may also cause hormonal changes making it difficult for a woman to become aroused or experience an orgasm. A woman should discuss these issues with her doctor, as changes in blood pressure medication or taking extra hormones may help the situation. Low blood levels can also be treated with erythropoietin; however, sometimes the actual dialysis treatment is the cause of fatigue.

COMMON QUESTIONS ABOUT REPRODUCTION AND PREGNANCY IN KIDNEY DISEASE, DIALYSIS AND TRANSPLANT PATIENTS

Is sexual intercourse safe for a patient with advanced kidney disease or patients on dialysis?

This is a common fear among such patients and there should be no such concern. Care should be taken to avoid damaging the dialysis access during sexual intercourse however.

Is sexual intercourse safe for patients with a kidney transplant?

As long as the scar from the transplant surgery is fully healed, blood pressure is controlled and the doctor says it is safe to resume or start sexual activity, there should be no reason to worry about damage to the transplant kidney.

What are the things that can affect a healthy pregnancy?

General health, age, presence or absence of high blood pressure, high blood sugar, or heart disease, presence of kidney disease. 

Can a woman with “mild” kidney disease have a baby? 

Women with mild kidney disease with little or no protein in the urine can conceive and have a healthy pregnancy. Women with more severe kidney disease have a lower likelihood of getting pregnant and higher chance of serious complications during pregnancy which might lead to loss of the pregnancy, worsening of the kidney disease or both. If you have any degree of kidney disease and want to become pregnant, make sure you talk to a kidney specialist along with the doctor that will care for your pregnancy.

Can a patient on dialysis have a baby? 

It is possible but changes in the bodies of men and women on dialysis make it hard to either impregnate a woman or become impregnated by a man. The risks to the mother and baby are quite high if a woman becomes pregnant on dialysis. If a woman becomes pregnant on dialysis, she will need close attention and very frequent dialysis to have a successful pregnancy. 

Can a kidney transplant patient have a baby?

Yes, a woman with a kidney transplant can have a baby. However, it is usually recommended that such patients wait at least 1-2 years after the transplant with stable kidney transplant function before trying to become pregnant. There should be no protein in the urine and the dose of steroids should be at least 15 mg a day or less. Before you try to become pregnant, tell your doctor because in addition to the tests needed to confirm it is safe to get pregnant, some of the medications used to prevent rejection of the transplant can affect the baby and need to be changed at least 6 weeks or more before any attempts to get pregnant. If the serum creatinine of a transplant patient is above a certain level, it is often recommended that the patient do not get pregnant in order to avoid the possibility of loosing the kidney transplant. Most pregnant kidney transplant patients will need to deliver by cesarean section although normal delivery has been reported. The obstetrician has to plan carefully on the surgical approach and has to consult with the nephrologist and if possible transplant surgeon to avoid damage to the transplant kidney during cesarean section surgery. 

What kind of birth control is recommended for patients with kidney disease?

Sometimes it is important to delay plans to become pregnant and birth control is needed. Women with kidney transplants or with high blood pressure should not use oral tablet or implanted hormonal contraceptives as these may increase the risk of rejection or deadly blood clots. These can also increase blood pressure and risk of events like stroke or heart attacks or heart failure. The safest options for birth control involve the use of condoms, diaphragms, sponges and the newer devices that can be placed in the uterus

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