Chronic renal disease and gravidity – case study

Česká verzia

Authors: B. Holman; I. Bryjová; A. Ježíková; P. Makovický; M. Mokáň
Authors place of work: I. interná klinika Jesseniovej lekárskej fakulty UK a MFN, Martin, Slovenská republika, prednosta prof. MUDr. Marián Mokáň, DrSc.
Published in the journal: Vnitř Lék 2006; 52(6): 640-644
Category: Case Reports

Summary

Uremia, the result of renal failure, is a serious clinical problem. Rising azotemia during gravidity significantly increases perinatal morbidity and mortality. This study presents the case of 34 years old patient with 27-year medical history of diabetes mellitus type 1 with diabetic nephropathy and chronic renal insufficiency. The patient got pregnant in the stage of preterminal renal failure. During the first trimester, she showed hypertension and proteinuria. In her 25th week of pregnancy, she was hospitalized with progressive proteinuria, almost uncontrollable hypertension and increased azotemia. Intensive conservative therapy led to a slight decrease of azotemia and proteinuria levels which, however, remained high. In fact, we considered using elimination methods several times. Due to severe hypoxia of the foetus, the gravidity was terminated by section at 30 weeks. After the parturition, the newborn had to be resuscitated. In the first days, the newborn showed increased azotemia which decreased spontaneously after several days. In a month after the termination of gravidity, N-substances increased again and the patient was enrolled in the chronic dialysis programme.

Key words:
chronic renal disease – gravidity

Zdroje

1. Confortini P, Galanti G, Ancona G et al. Full term pregnancy and successful delivery in a patient on chronic haemodialysis. Proc European Dialysis and Transplant Association 1971; 18: 74-78.

2. Hou S. Pregnancy in chronic renal insufficiency and end-stage renal disease. Am J Kidney Dis 1999; 33: 235-252.

3. Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. N Engl J Med 1996; 335: 226-232.

4. Levy DP, Giatras I, Jungers P. Pregnancy and end-stage renal disease - past experience and new insights. Nephrol Dial Transplant 1998; 13: 3005-3007.

5. Katz AI, Davison JM, Hayslett JP et al. Pregnancy in women with kidney disease. Kidney International 1980; 18: 192-206.

6. Cunningham FG, Cox SM, Harstad TW et at. Chronic renal disease and pregnancy outcome. Am J Obstet Gynecol 1990; 163: 453-459.

7. Jungers P, Houillier P, Forget D et al. Specific controversies concerning the natural history of renal disease in pregnancy. Am J Kidney Dis 1991; 17: 116-122.

8. Jungers P, Chauveau D. Pregnancy in renal disease. Kidney International 1997; 52: 871-885.

9. Purdy LP, Hantsch CE, Molitch ME et al. Effect of pregnancy on renal function in women with moderate to severe diabetic renal insufficiency. Diabets Care 1996; 19: 1067-1074.

10. Biesenbach G, Stoger H, Zazgornik J. Influence of pregnancy on progression of diabetic nephropathy and subsequent requirement of renal replacement therapy in female type I diabetic patients with impaired renal function. Nephrol Dial Transplant 1992; 7: 105-109.

11. Petri M. Systemic lupus erythematosus and pregnancy. Rheum Dis Clin N Am 1994; 20: 87-118.

12. Hayslett JP, Reece EA. Managing diabetic patient with nephropathy and other vascular complications. Baillieres Clin Obstet Gynaecol 1994; 8: 405-424.

13. Hou SH, Orlowski J, Pahl M et al. Pregnancy in women with end-stage renal disease: Treatment of anemia and premature labour. Am J Kidney Dis 1993; 21: 16-22.

14. Bucher HC, Guyatt GH, Cook RJ et al. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: A meta-analysis of randomized controlled trials. JAMA 1996; 275: 1113-1117.

15. Holman B, Strmeňová S, Makovický P et al. Difficulties with differential diagnosis and therapy of hypercalcaemia in the third trimester of pregnancy. Slovenský lekár 2002; 12: 21-22.

16. Prasad S, Parkhurst D, Morton MR et al. Increased delivery of haemodialysis assists successful pregnancy outcome in end-stage renal failure. Nephrology 2003; 8: 311-314.

17. Holley JL, Reddy SS. Pregnancy in dialysis patients: A review of outcomes, complications and management. Seminars in dialysis 2003; 16: 384-387.

18. Hou S. Pregnancy in dialysis patients: Where do we go from here? Seminars in dialysis 2003; 16: 376-378.

19. Shemin D. Dialysis in pregnant women with chronic kidney disease. Seminars in dialysis 2003; 16: 379-383.

20. Redrow M, Cherem L, Elliott J et al. Dialysis in the management of pregnant patients with renal insufficiency. Medicine 1988; 67: 199-208.