Book of Medical Disorders in Pregnancy - Tintash

with patients in this category. In patients
who have established oliguria and
anuria, we feel it is important to
establish a CVP line, hourly outputs of
urine must be done, preferably with an
indwelling catheter. Our first move in an
attempt to produce diuresis is to undertake
a trial of volume expanders’ using
intravenous glucose or Ringer's lactate.
Increasingly our experience has led
us away from the use of frusemide or
other diuretic agents, preferring instead a
flush of intravenous fluids to help
correct a shutdown kidney.
In cases where diuresis is not established,
consultation with a nephrologist
is mandatory. Indications for hemodialysis
or peritoneal dialysis are available
in all of the common texts dealing with
this subject. In our own unit, we prefer
hemo dialysis, but the lifesaving value of
peritoneal dialysis must not be forgotten.
When dialysis has been instituted, and
the condition is reversible, one will
hopefully see the anuria reversed and the
kidneys begin to function. In those cases
where intractable kidney damage has
been sustained, chronic dialysis may be
necessary. Those patients condemned to
chronic dialysis become candidates in
certain situations for renal transplant.
Renal transplantation in pregnancy -
In general, a patient who has received a
renal transplant and becomes pregnant
may be considered to be in the same
high risk group of patients as those who
have significant renal disease. The expected
complications correlate well with
the patients who have chronic renal disease
of some substance. As expected, the
outcome of the patient and her kidneys'
ability to withstand the stress of pregnancy,
are dependent upon the quality of
97
the graft function. In those patients with
renal transplant who are normotensive
and who have stable renal function, a
BUN of less than 2 mg. per 100 mI.,
who are on less than 10 mg. of prednisone
daily, and patients with Azathioprine
dosage which does not exceed 3
mg. per kilogram per day, a good out
come may be predicted. In the patient
undertaking pregnancy with a transplanted
kidney, careful monitoring such
as in chronic renal disease is mandatory.
The pre pregnancy function of the kidney
transplant does not always herald a
satisfactory outcome. Sudden alarming
deterioration of the kidney function has
been encountered in some of these cases.
The major problems noted in our unit
have been prematurity, unexplained premature
rupture of the membranes, intrauterine
growth retardation on the fetal
side, and on the maternal side deterioration
of renal function and pregnancy
induced hypertension. Because
of the increased risk to the fetus, it is
almost redundant to suggest careful
monitoring of the fetal maternal unit, as
well as the vigilant care of the mother
who undertakes this pregnancy at such
great risk.
With respect to the use of immuno
suppressive therapy during pregnancy in
cases of renal transplant, although theoretically
the incidence of fetal maldevelopment
should be increased, it is not
inevitable. However, appropriate antinatal
counseling should take place to
warn the woman with the renal transplant
who anticipates pregnancy of the
possible problems to both herself and her
fetus.
With respect to delivery of the patient
who has had a renal transplant, in our
own unit cesarean section has usually