Pregnancy complicated with chronic nephritis
Release time : 04/20/2025 09:30:01
Chronic nephritis in pregnancy is a primary kidney disorder characterized by glomerular lesions in both kidneys. Women with chronic nephritis in pregnancy experience increased renal burden during pregnancy, which affects kidney function. What is the disease and what is its pathogenesis? Let's discuss it together on MamaNet.
Pregnancy complicated with chronic nephritis is a primary kidney disease characterized by glomerular lesions in both kidneys. Pregnancy complicated with chronic nephritis often has a close association with streptococcal infection. Although pregnancy complicated with chronic nephritis may develop from acute nephritis, most cases are such at the onset of pregnancy and not transitioned from acute nephritis. In mild cases, it can easily be confused with preeclampsia, which lacks the necessary attention and leads to misdiagnosis of the condition.
Pregnancy complicated by chronic nephritis is more commonly seen in young women with a history of acute or chronic nephritis, characterized primarily by proteinuria, often accompanied by edema and hypertension, and is most frequently observed before the 20th week of gestation. Therefore, the diagnosis is not difficult.
In pregnant women with chronic nephritis, it is essential to initiate examinations as soon as possible, allowing the physician to diagnose the condition and monitor recovery progress. This facilitates further treatment planning. The following four examination methods are commonly used: 1. **Urinalysis**: This is the basic method of examination. It can detect proteins, red blood cells, and white blood cells in urine, assessing kidney function and whether there is inflammation present. 2. **Blood tests**: By taking a certain amount of blood, the levels of renal function indicators such as serum creatinine and urea nitrogen can be detected. These parameters reflect whether the kidney's filtration and excretion functions are normal. 3. **Functional tests**: These include measurements of glomerular filtration rate (GFR) and renal ultrasound imaging, providing an intuitive understanding of the structure and function of the kidneys. 4. **Immunological tests**: For example, antinuclear antibodies and anti-double-stranded DNA antibodies can help identify cases of autoimmune nephritis among other special situations. Through these examinations, the physician can comprehensively understand the patient's condition and develop an appropriate treatment plan. Adjustments may also be necessary during the treatment process.
1. Urine routine tests often detect the disease at pre-pregnancy or before 20 weeks of gestation, with the most significant presence of proteinuria in cases of chronic nephritis. In late stages of pregnancy-associated chronic nephritis, most glomeruli are damaged, and the leakage of protein is gradually reduced, thus a decrease in urinary protein does not necessarily indicate improvement in the condition, nor can it be used as a criterion for induced labor. Healthy kidneys should be capable of concentrating urine to a specific gravity of 1.020 or higher, whereas in late stages of pregnancy-associated chronic nephritis, due to impaired concentrating and diluting capacities, urine specific gravity tends to stabilize around 1.010. Depending on the severity of the disease, varying amounts of red cells and white blood cell casts may appear in the urine.
2. Blood tests indicate that in pregnancy with chronic nephritis, due to the significant loss of proteins and the destruction of renal parenchyma, there is a reduction in erythropoietin production, leading to anemia. This type of anemia is normal for hemoglobin and red blood cells. It is difficult to treat anemia associated with chronic kidney failure, and it is advisable to administer blood transfusions in small doses multiple times.
3. Renal function assessments reveal that renal function is less affected in the early stages of a disease, but by the late stages, various renal functions, such as the erythrocyte sedimentation rate test (ESR), serum creatinine, and the clearance of concentrated and diluted functions, have all experienced varying degrees of decline.
4. Fundus examination shows hemorrhage, exudation and typical inflammatory changes consistent with glomerulonephritis; mild chronic nephritis, the fundus examination can be normal.
Treatment Methods for Pregnancy Combined with Chronic Nephritis The impact of pregnancy combined with chronic nephritis on the fetus is significant. Therefore, once diagnosed, it is crucial for mothers to seek timely treatment. Delaying treatment will ultimately harm the baby's health. Here, we briefly discuss the treatment methods.
Prior to pregnancy, if there is hypertension and proteinuria, or when blood pressure is above 150/100mmHg (20/13.3kPa), or ureemia, pregnancy should not be considered. Once pregnant, artificial abortion should be performed as early as possible because pregnancy will increase the renal burden and easily cause preeclampsia, which is very unfavorable for both mother and child.
During pregnancy, it is essential to ensure sufficient sleep and rest, avoid fatigue, exposure to cold, infection, etc. Appropriate nutrition is crucial to enhance the body's resistance to illnesses. Active management of gestational hypertension should be pursued, with patients requiring a reduction in sodium intake.
Every week, routine urinalysis, serum creatinine, blood urea nitrogen, and uric acid are conducted.
If the renal function further deteriorates, or if blood pressure rises to above 150/100 mmHg (20/13.3 kPa) and cannot be controlled, termination of pregnancy should be considered. Serum creatinine concentration of 141.4 μmol/L can serve as an indicator for termination of pregnancy.
Sudden increase in blood pressure often occurs around the 36th week, which is prone to fetal death and renal failure. If necessary, termination of pregnancy should be performed.
For termination of pregnancy before 36 weeks, Dexamethasone can be used to promote fetal lung maturity.
Prevention of pregnancy complicated by chronic nephritis is possible for many diseases. The prevention methods mainly include the following six points, and all expectant mothers should pay attention to them as much as possible.
1. Avoid infection and other factors that can exacerbate the condition.
2. Strictly control diet to ensure adequate nutrition.
3. Actively control and treat complications.
4. Avoid or avoid the use of nephrotoxic and drugs that can induce renal damage.
5. Treatment with traditional Chinese medicine should be based on the patient's condition, diagnosis and treatment according to syndrome differentiation, formulate prescription, improve and delay the progression of renal failure using traditional Chinese therapeutic methods.
6. Perform relevant kidney tests during pregnancy.
The impact of chronic nephritis on pregnancy is undeniable, and it's important for expectant mothers to take this seriously. So, what are the specific effects? Is this overly alarmist? Let's delve into the matter together with Mama.com.
1. Effects on Pregnant Women.
Patients with pregnancy complicated with chronic nephritis may experience exacerbation of their condition postpartum, leading to acute renal failure and death.
2. Effects on the fetus.
The impact of pregnancy complicated by chronic nephritis on the fetus is related to the severity of the nephritis. In cases where the disease manifests in its early stages, with only proteinuria and without hypertension or serum creatinine levels exceeding 1.4mg/dL, the impact on the fetus is relatively minor. However, if the duration of the illness leads to a decline in placental function, it can affect the growth of the fetus within the uterus, resulting in delayed development or even intrauterine death.
It is important to note that pregnant women with hypertension, urea retention, or a serum creatinine level greater than 1.4 mg/dL are at an increased risk of renal deterioration, with a correspondingly higher likelihood of complications such as miscarriage, stillbirth, and neonatal death. In summary, the higher the blood pressure and the higher the serum creatinine levels, the greater the risk for maternal and fetal harm.
*The medical information provided in this text is for reference only.
In case of discomfort, it is advised to seek medical attention immediately for accurate diagnosis and treatment.