1/10. Successful pregnancy in a patient with polycystic kidney disease and advanced renal failure without prophylactic dialysis.Pregnancies in women suffering from advanced chronic renal failure are frequently associated with deterioration of maternal renal function, premature births and low birth weights. Prophylactic dialysis is sometimes instituted since this intervention ameliorates the uremic milieu and improves maternal status and fetal uterine environment. This report describes a successful pregnancy and delivery in a hypertensive woman with advanced chronic renal failure due to polycystic kidney disease without accelerating the natural deterioration of renal function and without instituting prophylactic dialysis. The infant was delivered at full term with a normal birth weight. Thirty months after delivery, growth and development of the child were normal and the rate of deterioration of maternal renal function, assessed by 1/creatinine, was unaffected by pregnancy. Conservative management and effective control of blood pressure may be sufficient to achieve successful pregnancy outcome when women with advanced chronic renal failure become pregnant.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/10. posterior leukoencephalopathy syndrome in poststreptococcal acute glomerulonephritis.Reversible posterior leukoencephalopathy syndrome is an increasingly recognized brain disorder most commonly associated with hypertension, toxemia of pregnancy, or the use of immunosuppressive agents. Its clinical features include headache, decreased alertness, mental abnormalities, such as confusion, diminished spontaneity of speech, changed behavior ranging from drowsiness to stupor, seizures, vomiting, and abnormalities of visual perception like cortical blindness. magnetic resonance imaging shows edematous lesions primarily involving the posterior supratentorial white matter and corticomedullary junction. We describe a 7-year-old uremic girl who developed neurological symptoms of posterior leukoencephalophaty syndrome during the course of acute poststreptococcal glomerulonephritis. Since the symptoms first appeared 24 h after a hypertensive crisis and the patient was uremic at the time of symptoms, we decided to report this patient to discuss the differential diagnosis of neurological symptoms developing during the course of acute poststreptococcal glomerulonephritis.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
3/10. Juxtaglomerular cell tumor in pregnancy.BACKGROUND: Although rare, two thirds of juxtaglomerular cell tumors of the kidney occur in young women in their reproductive years. CASE: A primigravid woman with a 6-year history of chronic hypertension was evaluated for the sudden onset of uncontrolled hypertension, proteinuria, and hypokalemia at 16 weeks' gestation. An abdominal sonogram revealed a left flank mass, and magnetic resonance imaging confirmed that the mass was of renal origin. The worsening hypertension was not controlled with labetolol, methyldopa, nifedipine, or hydralazine, and required a nitroglycerine drip. The patient had left nephrectomy and subsequently miscarried at 19 weeks' gestation. Her blood pressure gradually decreased and normalized within 6 months. A pathologic examination of the renal mass confirmed that it was a juxtaglomerular cell tumor. CONCLUSION: This tumor should be considered in the differential diagnosis as a cause of severe hypertension in pregnancy.- - - - - - - - - - ranking = 0.71428571428571keywords = pregnancy (Clic here for more details about this article) |
4/10. 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 = 0.57142857142857keywords = pregnancy (Clic here for more details about this article) |
5/10. Renal involvement in primary antiphospholipid syndrome and its response to immunosuppressive therapy.antiphospholipid syndrome (APS) is the association between antiphospholipid antibodies, venous and arterial thrombosis and pregnancy morbidity. Although the kidney may be affected in APS, the treatment of renal involvement is yet to be elucidated. This report describes the clinical and laboratory features of four patients with primary APS nephropathy, and the beneficial effect of immunosuppressive therapy accompanied by warfarin and angiotensin-converting enzyme inhibitor. We also briefly discuss the possible mechanisms of the beneficial effects of immunosuppressives on primary APS nephropathy.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
6/10. Prolonged survival with a remnant kidney.Surgical ablation of five-sixths renal mass in Munich-Wistar rats fed a high protein diet leads to focal sclerosis in the remnant kidney and progressive renal failure. Experimental data suggest that this injury results from intraglomerular hypertension and/or chronic glomerular hyperfiltration. Data in humans largely are limited to patients with unilateral renal agenesis or uninephrectomy, either for unilateral renal disease or for kidney transplant donation. Isolated case reports have documented focal sclerosis and progressive renal failure in two patients with a remnant kidney. To obtain data in humans with a remnant kidney, we surveyed more than 800 urologists and nephrologists in the united states and abroad. Criteria for inclusion in the study were (1) surgical resection (in one or more operations) resulting in the presence of a remnant kidney; and (2) an adequate period of follow-up, defined as 5 years or greater. A total of 13 patients were identified (from 13 different centers). Twelve patients had renal cancer and one had tuberculosis. Six patients were observed for 10 or more years postoperatively and all have stable serum creatinine levels of less than 270 mumol/L (3.0 mg/dL); two of these six patients are now more than 25 and 30 years postoperation. The other seven patients, observed for 5 to 7 years, have serum creatinine levels less than 270 mumol/L (3 mg/dL), while one has an increasing serum creatinine level. The two longest surviving patients both have undergone successful pregnancy with no overall change in serum creatinine. These observations demonstrate that it is possible for humans to survive more than 30 years with a stable serum creatinine, despite the presence of only a remnant kidney.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
7/10. Transluminal angioplasty for renovascular hypertension complicated by pregnancy.Percutaneous transluminal angioplasty was successfully used in the treatment of renovascular hypertension that resulted from fibromuscular hyperplasia in a 26-year-old woman who was four weeks' pregnant. The patient's BP normalized immediately. She had a normal pregnancy that terminated in the delivery of a full-term normal child. Two and a half years after the procedure, she remained normotensive without taking antihypertensive medication. Percutaneous transluminal angioplasty may be useful in the treatment of renal artery stenosis complicated by hypertension and pregnancy, where the inherent risk of toxemia endangers the life of the mother and fetus.- - - - - - - - - - ranking = 0.85714285714286keywords = pregnancy (Clic here for more details about this article) |
8/10. Total parenteral nutrition in a pregnant insulin-requiring diabetic.A 28-year-old class F diabetic woman whose pregnancy was complicated by gastroparesis, hemorrhagic gastritis, narcotic addiction, intrauterine fetal growth retardation, and severe preeclampsia was supported with total parenteral nutrition (TPN) from the 27th to the 29th week or pregnancy. During this period there was adequate control of serum glucose, a positive nitrogen balance, and a normal amino acid profile. Unfortunately, a rapid deterioration in renal function and hypertensive disease occurred, requiring cesarean section at the 29th gestational week. TPN was continued for an additional 30 days postoperatively until the gastritis resolved and adequate oral nutrition could be reestablished. wound healing was satisfactory.- - - - - - - - - - ranking = 0.28571428571429keywords = pregnancy (Clic here for more details about this article) |
9/10. Orthotopic renal autotransplantation in the treatment of renovascular hypertension.Severe hypertension non-responsive to medical therapy was discovered in a 27-year-old woman in the third trimester of pregnancy. Renal arteriography after delivery revealed bilateral renal artery stenosis. The right kidney was smaller than the left one. The differential renal function studies, rather than the renal vein renin measurements, identified which side was causing the hypertension. An attempt at primary repair of the right renal artery failed. Orthotopic renal autotransplantation, using saphenous vein grafts that were interposed between the renal veins and the inferior vena cava, and between the segmental renal arteries and the abdominal aorta, reduced the blood pressure to normal values.- - - - - - - - - - ranking = 0.14285714285714keywords = pregnancy (Clic here for more details about this article) |
10/10. Reversible hypertension in pregnancy caused by obstructive uropathy.BACKGROUND: hypertension with deterioration of renal function after mid-pregnancy often signifies preeclampsia and the need for delivery. CASES: We have encountered three women with reversible hypertension related to obstructive uropathy. The women presented between 21-30 weeks' gestation with hypertension accompanied by significantly increased serum creatinine. Although pregnancy-induced hypertension was considered initially in all, there was no other evidence of preeclampsia. In all three, ureteral obstruction was confirmed radiographically and found to be associated with uterine overdistention or congenital urinary anomalies. Relief of obstruction by ureteral stent placement or percutaneous nephrostomy was followed by diuresis and resolution of hypertension. In all three women, pregnancy was extended by more than 6 weeks. CONCLUSION: Urinary obstruction is a rare but potentially reversible cause of hypertension in pregnancy. Relief of obstruction may lead to normalization of blood pressure and negate the need for immediate delivery.- - - - - - - - - - ranking = 1.1428571428571keywords = pregnancy (Clic here for more details about this article) |
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