Table 1.

Some bioethical questions waiting for answers regarding pregnant women with chronic kidney disease (CKD) and related diseases.

Question	Key Points
Is it there a risk threshold for discouraging/forbidding pregnancy in CKD?	None established, context-sensitive, and insufficient evidence of counselling for women with severe or rare conditions.
What is the role of the physician in counselling?	No model of physician–patient interaction is deemed superior to others and the role is context-sensitive (paternalism, therapeutic alliance, informative, etc.).
In pregnancies that are at a high risk for early pre-term delivery, what is the weight of the associated risks for the baby?	This is an example of maternal–foetal conflict: pregnancy in dialysis, with stages 4–5 CKD (proteinuria and hypertension, or with a failing kidney graft) is associated with early pre-term delivery and small babies. The mother’s right to self-determination may conflict with the risk of disability in the offspring.
What is the importance of the risk of impairing residual kidney function (or causing loss of a kidney graft) in a high-risk CKD pregnancy?	This is an issue that has an individual valence (risk of end-stage kidney disease) and a social one (costs of renal replacement therapy and competition for kidney transplantation).
What is the role of genetic counselling and genetic selection in patients with late-onset diseases?	This is the case, for example, for polycystic kidney disease, whose high genetic frequency does not correspond to clinical disease. It generally develops in the 3rd and 4th decade of life, making it difficult to foresee what CKD treatment will be available when the disease becomes clinically overt in the offspring.