Book of Medical Disorders in Pregnancy - Tintash

A clear cut history of streptococcal
infection of the throat, going on to the
development of hematuria (tea like
urine) and generalized oedema may raise
suspicion. The urine demonstrates
significantly elevated protein, with blood
and granular casts. BUN. Is usually
somewhat elevated? In some cases,
hypertension will develop. It is in this
context that the addition of pregnancy
induced hypertension becomes an
additional hazard, treatment consists of
rest.
Adequate diet (which in some cases is
considered to be advantageously proteinsparing),
careful observation of the pregnancy,
and in rare instances termination
of the pregnancy if deterioration is in
evidence. The broad range of possible
renal involvement makes it mandatory
that each case must be individually dealt
with.
ii) Chronic glomerulonephritis (chronic
nephritis) unfortunately, the definitive
diagnosis of chronic glomerulonephritis
in pregnancy is very difficult, and
therefore many patients manifest in
abnormal proteinuria and some elevation
of BUN. With or without hypertension,
will be assigned to this category of
disease for lack of accurate diagnosis. In
all cases presenting in this category,
careful history and physical examination
including examination of the eyegrounds
and blood pressure must be carried out.
This coupled with BUN, creatinine
clearance rate, and careful examinations
of the urinary sediment are most
important.
In the event (as is commonly the case)
that accurate designation of the disease
process cannot be achieved during
pregnancy, then the plan of management
93
should be expectant; increased rest,
possibly hospitalization depending upon
the severity of the situation, with careful
surveillance for the onset of pregnancy
induced hypertension or failure of the
pregnancy to grow at an appropriate rate.
The risk basically in this category of
patients is the establishment of pregnancy
induced hypertension (PIH) or
preeclampsia and with it the developpment
of intrauterine growth retardation,
the risk of abruptio placentae, and other
catastrophic complications.
The difficulty in establishing the prognosis
for patients in this form of
chronic renal disease is acknowledged
by most workers in the field. In cases
that have been diagnosed prior to the
pregnancy and the disease process
worked out by renal biopsy, a more
reasonable prognosis may be offered
although, in some of the most severe and
florid cases of advanced renal disease,
pregnancy may be surprisingly well
tolerated. The most important step in
assessing the prognosis and carrying the
patient through pregnancy is a history of
the details of previous pregnancies.
If the patient has normal blood pressure,
modest amounts of proteinuria, normal
BUN, creatinine and creatinine clearance
care should be taken through her
pregnancy with a satisfactory fetal and
maternal outcome. In a relatively large
series of patients with documented
('chronic nephritis" frees of hypertension
and proteinuria, essentially normal fetal
and maternal outcome was demonstrated.
In those cases that demonstrated
proteinuria, in the absence of hypertension,
a generally favorable outcome
was noted, while fetal mortality was
increased moderately. In those cases
combining hypertension and proteinuria,