Why obstetric nephrology matters

The well-attended Irish Nephrology Society Winter Meeting 2026 took place on 23–24 January at the Imperial Hotel, Cork.

An update in obstetric nephrology was provided to delegates in the first session of the meeting by Dr Bláthnaid O’Connell, Aspire Fellow, Cork University Hospital.

Dr O’Connell began her presentation by outlining “why obstetric nephrology matters”.

“Kidney disease significantly affects maternal and renal outcomes and pregnancy can unmask underlying renal pathology,” Dr O’Connell stated.

“So, it’s often a woman’s first sustained contact with healthcare. It’s becoming increasingly relevant because of the rise in chronic kidney disease (CKD) prevalence. This is due to medical advances, improved survival, post-transplant pregnancies, and advanced maternal age.”

She added how CKD is becoming increasingly common in women of reproductive age, due to co-morbidities such as hypertension, obesity, and diabetes.

CKD is now affecting between 1 and 2.6 per cent of pregnancies in high-income countries and is higher in low- and middle-income countries, impacting between 4 and 26 per cent of pregnancies, Dr O’Connell stated.

“Hypertensive disorders including preeclampsia affect up to 10 per cent of pregnancies and are the most common renal complication we see,” she noted.

“Preeclampsia is a leading cause of PRAKI [pregnancy-related acute kidney injury], ICU admission, and pre-term delivery.”

Patients with PRAKI have a 52-fold increased risk of adverse renal outcomes and a nine-fold increased risk of maternal death long-term.

Dr O’Connell added that both PRAKI and preeclampsia carry significant short- and long-term renal risk.

She said that recent data regarding rare kidney disease has enabled clinicians to provide more personalised risk discussions around pregnancy and kidney disease.

Dr O’Connell noted how the PREDICT tool, which forecasts the progression of CKD, provides pregnancy-calibrated renal risk.

Dr O’Connell welcomed the fact that all women with gestational diabetes and preeclampsia since January 2023 are included in a primary care prevention programme.

“It would be great if PRAKI was to follow, but there is no talk of that currently,” she added.

“Our aim should be to try and prevent chronic kidney disease, cardiovascular disease, and multigenerational cardiometabolic disease going forward.”