1/61. Successful obstetric outcome after simultaneous pancreas and kidney transplantation.A 34-year-old woman became pregnant two years after having a simultaneous pancreas and kidney (SPK) transplantation, necessitated by type 1 diabetes and end-stage renal disease. The pregnancy was uneventful until 30 weeks' gestation, when she developed pancreatitis and a worsening of mild hypertension. A healthy 1700 g boy was delivered by caesarean section at 34 weeks' gestation. This is the first report of a successful pregnancy after SPK transplantation in australia.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/61. Pregnancy and the dialysis patient.Pregnancy in the dialysis patient is a rare occurrence. When pregnancy does occur, the risk of spontaneous abortion, stillbirth and neonatal complications such as prematurity and growth retardation are fairly high. This paper discusses issues surrounding pregnancy and the dialysis patient. It also follows the pregnancy of one hemodialysis patient at The Toronto Hospital. Guidelines for the care of pregnant dialysis patients are reviewed.- - - - - - - - - - ranking = 1.5keywords = pregnancy (Clic here for more details about this article) |
3/61. dialysis and pregnancy--a case report and review of the literature.We report on a patient with an eight-year history on maintenance hemodialysis treatment without residual renal function in whom pregnancy was successfully managed through to the 29th week. During this time, under carefully modified dialysis treatment, the nephrologic course, as well as materno-fetal flow relationships were unremarkable. fetal development was appropriate for gestational age. However, pregnancy was complicated by polyhydramnios, which necessitated i.v. tocolysis. In the 28 6th week of gestation, cesarean section was performed because of an antibiotic-resistant fever of unclear origin which ceased within two days of delivery. Although the postnatal course of the adequately developed baby was complicated by the respiratory distress syndrome, normal development continued. We emphasize that the intensive interdisciplinary cooperation of nephrologists and obstetricians is imperative for the successful management of pregnancy under these conditions. In these pregnancies, the main fetal problems consist of premature labor because of polyhydramnios, preterm delivery, intrauterine growth retardation and stillbirth. The mother is threatened by the development of superimposed pre-eclampsia, left ventricular failure because of volume overload and progressive anemia. In order to maintain a well-balanced homeostasis, intensification of dialysis therapy by an increase in frequency and duration is the most important therapeutic approach. Accurate fetal monitoring including frequent examination of the feto-maternal circulation by Doppler sonography as well as attentive surveillance of the mother is required to recognize the above mentioned complications.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
4/61. Bioelectrical impedance analysis in the clinical management of a pregnant woman undergoing dialysis.We report a case of successful pregnancy in a woman who was initially diagnosed with renal failure in mid-pregnancy. She was started on hemodialysis, and her fluid balance was serially monitored with bioelectrical impedance analysis. Her body weight decreased and bioelectrical impedance values increased, along with resolution of pulmonary edema in the process of the removal of excessive fluid retention with hemodialysis. The bioelectrical impedance values decreased immediately after the usual dose of oral ritodrine was administered, partly because producing sodium and water retention by ritodrine were enhanced in the setting of fluid imbalances. This decrease preceded the onset of pulmonary edema, while no changes were noted in maternal body weight before hemodialysis. These results suggest that the serial measurement of bioelectrical impedance values enables more reliable and earlier detection of abnormal water retention in pregnant women undergoing dialysis than the effect of body weight changes.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
5/61. Idiopathic CD4 T cell lymphocytopenia evolving to monoclonal immunoglobulins and progressive renal damage responsive to IL-2 therapy.Idiopathic CD4 T cell lymphocytopenia was unexpectedly detected in a 33-year-old, otherwise healthy young woman with no hiv or other viral infection, autoimmune, or neoplastic disease or increased susceptibility to infection. CD4 T cell levels were 60-140/microl over a 3.5-year period. Following an uneventful pregnancy, the patient developed anemia and interstitial nephritis associated with a plasma cell dyscrasia with a monoclonal IgA gammopathy and a shifting immunoglobulin pattern that included IgG and IgA monoclonal proteins and increased urinary light chains. Osteolytic lesions were never detected and bone marrow aspirations revealed up to 10% atypical plasma cells. Various therapies often used in treating multiple myeloma only temporarily controlled the increasing renal damage. IL-2 therapy of 600,000 to 1 million units subcutaneously daily resulted in increased CD4 T cells to normal levels, a decrease in the gammopathy, a return of renal function, energy, and weight gain, and apparently normal health status sustained for 2 years. The findings are compatible with a potentially fatal but nonmalignant immunoregulatory disorder that can be controlled by IL-2 administration.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
6/61. kidney transplantation during the first trimester of pregnancy: immunosuppression with mycophenolate mofetil, tacrolimus, and prednisone.We present a case of living, related-donor kidney transplantation during the first trimester of pregnancy. The patient received mycophenolate mofetil (MMF), tacrolimus, and prednisone throughout the entire pregnancy. This is the first reported case of use of MMF during pregnancy. The mother did well, except for mild preeclampsia and mild renal insufficiency at term. The baby girl was born prematurely at week 353/7. The only possible teratogenic effects detected included hypoplastic nails and short fifth fingers. No chromosomal abnormalities were found. The child is growing and developing normally. Although we do not recommend the use of mycophenolate mofetil during pregnancy based on this experience, it is reassuring to know that a successful outcome can be expected in mothers treated with MMF during pregnancy.- - - - - - - - - - ranking = 4.5keywords = pregnancy (Clic here for more details about this article) |
7/61. Successful pregnancy outcome in advanced chronic renal failure.A 24 years female of advanced chronic renal failure due to lupus nephritis presented with pregnancy of eight weeks duration she continued the pregnancy against medical advice. At 29 weeks gestation further deterioration of renal function prompted weekly dialysis and hospitalisation for intensive maternal and fetal monitoring. At 35 weeks she was safely delivered by elective caesarian section. This is the first case of dialysis during pregnancy to be reported from india.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
8/61. Pregnancy during chronic hemodialysis: a single dialysis-unit experience with five cases.BACKGROUND: Pregnancy is uncommon in women with end-stage renal disease (ESRD) requiring chronic dialysis. An increasing number of successful pregnancies in women in hemodialytic treatment have been recently reported but few institutions experienced more than one or two cases of pregnancy. methods: Between 1988-1998 five pregnancies in patients receiving hemodialysis were observed in our center. medical records of these patients were reviewed. RESULTS: At the conception the mean age was 27 years. One patient started dialysis after conception. All patients received bicarbonate dialysis. Three patients were dialyzed six times per week, the other two patients three-four times per week. The dry weight was increased progressively; on average of 1.2 /- 0.5 kg in the first trimester and of 0.5 kg per week since the second trimester. The predialysis BUN was maintained between 50-100 mg/dL (17.85-35,70 mmol/L) during the pregnancy. Four patients were treated with erythropoietin to maintain hematocrit between 30-35%. erythropoietin related-complications were not observed. polyhydramnios was observed in all cases. All deliveries occurred before term. The mean gestational age of infants was 28.6 /- 4 weeks. Four out of five pregnancies resulted in liveborn infants. Two infants had an apgar score of zero. All neonates were of low birth weight (1,431 /- 738 g) with percentile of birth weight in the normal range. No one was small for date. CONCLUSION: A successful pregnancy is possible in women on chronic dialysis. Prematurity occurs frequently as well as low weight birth leading to increased perinatal morbidity and mortality.- - - - - - - - - - ranking = 1.5keywords = pregnancy (Clic here for more details about this article) |
9/61. Scleroderma renal crisis in pregnancy associated with massive proteinuria.Scleroderma renal crisis is a well-recognized complication of systemic sclerosis (SSc) usually occurring early in the course of the disease in patients with diffuse skin involvement. We report the diagnostic challenge of a case of scleroderma renal crisis associated with massive proteinuria at approximately 20 weeks gestation in a pregnant patient with diffuse cutaneous systemic sclerosis.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
10/61. Minimal change glomerulopathy in pregnancy.Chronic kidney disease (CKD) is a health care issue confronting women during their childbearing years. The purpose of this manuscript is to explore the pathophysiology of one type of renal glomerular disease minimal change disease. Glomerular physiology is examined along with renal adaptations occurring during pregnancy. Treatments, nursing interventions, and a case study are presented. Pregnancy outcomes are illustrated when a reciprocating kidney disease state exists.- - - - - - - - - - ranking = 2.5keywords = pregnancy (Clic here for more details about this article) |
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