Medical management of a pregnancy woman with moderate renal insufficiency and superimposed preclampsia
Grażyna Orłowska-Kowalik, Teresa Małecka-Massalska, Andrzej Książek
Am J Case Rep 2009; 10:93-98
Background: Renal insufficiency in pregnancy intensifies various risk factors for both the mother and child. Risk factors for the child include the risk of premature birth, low birth weight, retarded fetal development, mental retardation and polyhydramnios. The most pronounce risk factors for the mother is a progression of renal insufficiency into chronic renal failure, requiring renal replacement therapy. Complication associated with gestation in women with coexistent renal insufficiency may lead to the development and or aggravation of hypertension, albuminuria, HELLP syndrome, pre-eclampsia or eclampsia.
Case Report: We present the case of a 34-year-old woman, with hypertension and a twelve year history of moderate renal insufficiency diagnosed as glomerulonephritis, who became pregnant. Progressive renal insufficiency was noted during each trimester of the pregnancy, with decreases in GFR, RBC, albumin, plasma protein, hemoglobin (Hb)/hematocrit (Hct), as well as increased plasma urea, serum creatinine (urea and creatinine are GFR markers) and proteinuria.
Conclusions: Careful and continual medical care is essential for pregnant women who present with renal insufficiency, to ensure fewer complication and survival of both mother and child. Management and correction of any renal parameter, when possible, should immediately be instituted. Fetal development should be continually monitored by ultrasonography. The best approach to management of care for pregnant women with renal insufficiency and pre-imposed pre-clampsia can be accomplished with a multidisciplinary team of specialist, which includes nephrologists, obstetricians, nutritionist and pediatricians.
Keywords: pre-clampsia, Glomerulonephritis, renal insufficiency, chronic renal failure, Pregnancy