Abstract
Various factors have been suggested for the etiology of toxemia of pregnancy, but the cause or causes remain obscure. Particularly, the pathogenesis of eclampsia, which is accompanied by the sudden onset of generalized tonic and/or intermittent convulsions and syncope, in complex. However, placental toxic substances, which possess a convulsion-inducing property, are thought to be one of the factors causing eclampsia, and also related to the occurrence of renal failure and disseminated intravascular coagulation (DIC) seen as the complications. Eclampsia is often associated with serious complications and the prognosis is rather poor.
It is ideal to treat the patients with eclampsia without leaving irreversible hypertension, renal failure or DIC behind. However, there has been no definitive therapy for eclampsia. Hemodialysis (HD) was actively induced for the treatment of five patients with a confirmed diagnosis of eclampsia, according to the theory that in vivo (placental?) toxic substances may be responsible for the onset of eclampsia.
Acute renal failure (ARF) developed in one patient probably because of a long gap of time between the seizure of convulsions and the induction of HD. However, the prominent improvement of clinical symptoms and signs was observed in the remaining four cases by the early induction of HD. No serious complications were noted in these patients and they were cured completely. Two other eclamptic patients were treated with the direct hemoperfusion (DHP) from a view point of the removal of toxic substances and the therapeutic efficacy was dramatic. It was especially effective in the improvement of consciousness, the prevention of serious complications and the teratment of DIC. Although the number of the patients treated was too small to conclude the therapeutic significance and appropriateness of HD and DHP in the treatment of eclampsia, they can be evaluated since no side effects were recognized and sufficient clinical efficacy was obtained. Guanidino compounds (GC), recently calling attention as contributing to uremic toxins, also possess a strong convulsive property. The analysis of GC was attempted because of the possibility of their relationship to the pathogenesis of eclampsia. However, it was impossible to detect them in the eclamptic patients. Further study is neccessary in regard to GC.
