“Embarazo en una paciente con enfermedad renal crónica en hemodialisis”

Abstract

Chronic kidney disease is seen in approximately 4% of women in the reproductive stage, and includes both primary renal diseases and secondary to a systemic disorder. However, the association of advanced chronic kidney disease (ACKD) in stage 5D and gestation is an infrequent event, with a variable incidence. (1) We present the case of a 26-year-old female patient with a personal history of untreated hypertension (HTA) and primary glomerulopathy, which led to renal failure in stage 5D diagnosed one year ago in three-week treatment with hemodialysis. Within her gynecological-obstetric history: family planning method, her menstrual cycles were irregular; previous deeds: two, masculine, live births, without complications; gesta 3: current unknown date of last menstruation (FUM). Patient goes to nephrology control with obstetric echo that reports pregnancy of 15.1 weeks. Change of hemodialysis therapy is indicated to 5 times per week and it is immediately referred to the gynecology and obstetrics service where it carries out pregnancy uptake and subsequently goes to 2 more controls. At 31.1 weeks of gestation, she went to prenatal control, referring to headache and edema at the level of the lower limbs. She is admitted to the Obstetrics-Gynecology service where she stays hospitalized for 26 hours and receives antihypertensive treatment, pulmonary maturation and later is transferred from emergency to third level with a diagnosis of: Pregnancy of 31.2 weeks by Extrapolated Echo + Chronic Hypertension + Preeclampsia Sobreañadida + HELLP syndrome. In the third level, pregnancy is terminated by means of an emergency caesarean section, obtaining a live male product, which remains for 27 days in the neonatal care unit after which it passes away due to sepsis of early origin due to Streptococcus pneumoniae