Women with chronic kidney disease (CKD) are faced with complex decisions and significant challenges during their reproductive years. Contraceptive choices have a variety of side effects that can disproportionately affect women with CKD, limiting choice. CKD itself and the therapies needed to treat severe disease can affect future fertility. When conception is desired, young women with CKD must plan meticulously because an ill-timed pregnancy can result in disease progression or flare and exposure of an unborn child to potentially teratogenic medications. Among women with CKD, pregnancy risks are substantial, with up to 10-fold higher risk for preeclampsia and 6-fold higher risk for preterm delivery. These pregnancy complications associated with inadequate placentation also increase maternal and newborn risks for cardiovascular morbidity and mortality and progression to kidney failure later in life. As such, it is the obligation of every nephrologist caring for women of reproductive age to provide guidance in the choice of methods to prevent unplanned pregnancies, to choose treatments that preserve fertility, and to participate in shared decision making that optimizes pregnancy timing and outcomes. In this perspective, we review the many challenges associated with reproductive counseling in women with CKD.

患有慢性肾脏病（CKD）的妇女在其生殖年中面临着复杂的决定和重大挑战。避孕选择具有多种副作用，这些副作用会严重影响患有CKD的女性，限制了选择。CKD本身和治疗严重疾病所需的疗法可能会影响未来的生育能力。当需要怀孕时，患有CKD的年轻妇女必须精心计划，因为不适当的怀孕会导致疾病进展或耀斑，并使未出生的孩子接触潜在的致畸药物。在患有CKD的女性中，妊娠风险很高，先兆子痫的风险高10倍，早产的风险高6倍。这些与胎盘不足有关的妊娠并发症也增加了母亲和新生儿罹患心血管疾病和死亡的风险，并增加了生命后期发展为肾衰竭的风险。因此，每位照顾育龄妇女的肾脏病医生都有义务在选择预防意外怀孕的方法，提供保留生育能力的治疗方法以及参与共同决策以优化怀孕时机和结果的方法方面提供指导。从这个角度出发，我们回顾了CKD女性与生殖咨询相关的许多挑战。选择保留生育力的治疗方法，并参与共同的决策，以优化怀孕时机和结果。从这个角度出发，我们回顾了与CKD女性生殖咨询相关的许多挑战。选择保留生育力的治疗方法，并参与共同的决策，以优化怀孕时机和结果。从这个角度出发，我们回顾了与CKD女性生殖咨询相关的许多挑战。