Q: I am a 25-year-old female. I was diagnosed with chronic kidney disease a year back. I also have high blood pressure. Presently, my creatinine is 3.7 and blood urea is 83. Doctors said that they could not conduct a biopsy as my kidneys are small. It was seen through Doppler test that my kidney size is small and that it is functioning poorly. Currently, I am taking Minipress 2.5 twice daily, Amlodac 10 twice and Envas 2.5. I am not married yet. Can I have a normal married life? Can I have children and what are my chances of survival?

A:Female patients with advanced chronic disease as in your case tend to have disturbances in menstruation, fertility and sexual function all resulting from the hormonal and chemical imbalance. All this rarely results in a successful pregnancy along with increased incidence of premature delivery, fetal (unborn child) morbidity and mortality. Initiation of regular dialysis treatment sessions during the stage of kidney failure(defined as having less than 10% of normal kidney function at your age) along with the management of the complications of kidney failure including anaemia and malnutrition may rarely improve the chances of fertility and a successful pregnancy. Even though the kidneys are small in size, it would be important to perform a CT scan or an ultrasound guided kidney biopsy to find out the cause of kidney disease at such a young age. Later, I suggest getting a kidney transplant from a potential matching donor, better if it is of your family members, once you reach the stage of kidney failure. This is important since kidney transplant unlike dialysis has excellent long-term outcome on the quality of life along with the reversal of most of the menstrual and hormonal abnormalities. However, one would need to wait at least a year after receiving the kidney transplant before planning the pregnancy which most often has a successful outcome.