A 27-year-old Chinese woman diagnosed with CRF secondary to Shönlein-Henoch disease that had been controlled for years in outpatient clinics.
Leukocytoclastic vasculitis was diagnosed by skin biopsy and a mesangial proliferative glomerulone with 42% semilunar fluid at the renal biopsy.
He started HD in August 2009.
A study was initiated for inclusion in the kidney transplant waiting list.
Pregnancy was confirmed in November 2009.
Table 1 shows the main changes in HD regimen after being informed of the positive pregnancy test of the patient.
1.
Initially, IV iron was discontinued because its safety has not been demonstrated and there are doubts about the acute toxicity of iron in the fetus.
However, many groups routinely administer it and what is recommended is to reduce daily doses15.
In this case, it was replaced by oral iron, but intravenous iron had also to be reintroduced weekly after week 24.
Regarding erythropoietin, its use during pregnancy has been shown to be safe, with no increase in blood pressure or teratogenicity documented16.
Note that the previous treatment was the one that took up to week 6, which is when the situation is known.
Table 2 shows the evolution data in weight and TA of the patient throughout pregnancy.
An exhaustive control of the AT was made.
At week 8 there was an increase of this but it was controlled keeping the entire pregnancy systolic AT around 120-130mmHg.
When risk was assessed, a tendency to hypertension was chosen with the objective of reducing the possibilities of intradialytic hypotension that has the worst consequences
1.
The patient had started HD a short time ago so the flow increased progressively according to the mature AVF.
The daily UF was 0.6-0.7l/h which, in addition to maintaining diuresis of 800cc per day, indicates that the patient drank plenty of fluid.
Other parameters are shown in Table 3.
1.
Numerous controls and controls were performed, especially in the last stage where polyhydramnios is observed that is increasing despite the measures adopted.
1.
She was admitted at 31 weeks of pregnancy with congenital malformations.
Urgent cesarean section is considered due to the presentation pod and the tract is used to try to inhibit labor and steroids for lung maturation.
Performing emergency cesarean section almost three more times.
A polyhydramnios between 2.5-2.8 was quantified.
The placenta weighed 540 g.
The child weighed 2,250 g.
That same day, the mother's dialysis was resumed, returning to pre-pregnancy guidelines, and she was discharged six days later.
The child was admitted to the neonatal ICU for the first 24 hours as a prevention.
There were no malformations, with an Apgar score of 9 in the first minute and 9 in the fifth.
She enjoyed mixed breastfeeding.
The analytical analysis showed a high creatinine level of 4.5 mg/dl in the child at birth, which by its own means corrected to 0.7 after 24 hours.
The postpartum period was reviewed one and a half months later, with all normal parameters and highlighting that the patient had menstruation again at that time.
