Successful pregnancy and delivery in two patients with chronic renal failure

Abstract

Patients with chronic renal failure (CRF) incur high risks in pregnancy, and it is difficult for them to have babies. We report 2 cases of successful pregnancy and delivery managed with hemodialysis treatment.
The first case was a 29-year-old woman who came to our hospital at 15 weeks' gestation. Her serum Cr was 4.4mg/dl, and we were afraid that her renal failure might progress during gestation. But she strongly insisted on having a baby, and her course was monitored as an inpatient. At 21 weeks' gestation, her BUN rose to 77.9mg/dl and her Cr was 5.2mg/dl. Hemodialysis was carried out 3 to 4 times weekly with the goal of keeping her predialysis BUN below 50mg/dl. She also required 32 units of blood to keep her hematocrit above 25%. Danger of premature labour occured at 23 weeks, but pregnancy was maintained until 32 weeks. She gave transvaginal birth to a male infant weighing 1, 790g with an Apgar score of 8. During the postpartum period, the mother and baby had no problems and hemodialysis was discontinued.
The second case was a 30-year-old woman who started dialysis at 27 years old who had CRF due to chronic glomerulonephritis. She was transferred to our hospital at 19 weeks of gestation. She was dialysed 4 times weekly to maintain her BUN below 50mg/dl. She was also transfused with 34 units of blood to keep her hematocrit above 25%. At 33 weeks she transvaginally delivered a boy weighing 1, 690g with an Apgar score of 9.
Although few data exist on pregnancy in patients with renal failure, successful pregnancy may be maintained by careful and intensive management.