Review of basic anatomic and physiologic changes in renal function during pregnancy and implications of these changes. This chapter highlights the impact of renal disease on pregnancy, fetal outcomes, and anesthetic management. The etiology and severity of chronic renal disease, end stage renal disease, and those who have had a renal allograft all have a crucial impact on pregnancy. These are all critically important to the obstetric anesthesiologist.

This chapter will present clinical and histopathologic findings, pathophysiology and molecular genetics of glomerular basement membrane (GBM) diseases presenting primarily with hematuria. The GBM is a complex structure mainly composed of collagen IV in its mature form, but also other components such as nidogen, agrin and perlecan. Diseases of collagen IV disorders include Alport syndrome and thin basement membrane disease, Pierson syndrome, caused by mutations in the LAMB2 gene, nail–patella syndrome caused by LMX1B mutations with collagen type III accumulation that requires unmasking, and type III collagenopathy characterised by increased type III collagen in the GBM and the glomerular mesangium. Current and future therapies will also be discussed