Nephropathy of pregnant
women Nephropathy of pregnant women is a clinical form of late toxicosis. This is a set of symptoms that can accompany a woman in the second half of pregnancy. A similar disorder appears in young women during the first pregnancy, as well as after 35 years. Multiple pregnancies increase the risk of developing nephropathy. In general, it occurs in 15 percent of pregnant women. In addition, nephropathy is found in almost half of expectant mothers suffering from extragenital diseases.
The content of the article:
Causes of nephropathy of pregnant
women Symptoms of nephropathy
Diagnosis of nephropathy of pregnant
women Treatment of nephropathy of pregnant women
Prognosis for nephropathy of pregnant
women Prevention of nephropathy of pregnant
women Nephropathy of pregnant
women Nephropathy of pregnant women is characterized by:
hypertension (sustained increase in blood pressure);
edema;
proteinuria (increased protein content in the urine).
Although this disorder is localized in the kidneys, it does not cause much harm to these organs. As a rule, after giving birth, a woman forgets about nephropathy. But if the patient does not receive proper treatment, nephropathy can turn into severe forms:
preeclampsia, which threatens the functioning of the placenta;
eclampsia, which entails hemodynamic disorders and threatens the life of the mother and fetus.
With the progression of complications of nephropathy, there is a multiple increase in the protein content in the urine, and the volume of fluid excreted from the body reaches a level of half a liter or lower. This indicates the development of kidney failure in a pregnant woman, in which the kidneys cease to perform their main functions. It is obvious that in such a disease as nephropathy of pregnant women, the consequences can be the most terrible, so its appearance cannot be ignored.
Causes of nephropathy in pregnant women
Science still cannot give an exact answer to the question why pregnant women develop nephropathy. To date, there are several dozen theories on this score. Some of them have already lost their relevance or have been refuted:
fetal theory of the genesis of nephropathy: the mother’s body is poisoned by fetal metabolic products;
allergic theory of the genesis of nephropathy: protein substances with allergenic properties are formed in the placenta or in the fetus, which adversely affect the mother’s body.
For a long time it was believed that the main cause of the appearance of late toxicosis of pregnant women are hemodynamic disorders in the kidneys. Initially, scientists were of the opinion that pregnancy provokes kidney disease. Later, they began to take into account the pressure of the uterus on these organs, causing ischemia. However, observations have shown that nephropathy can also be detected in the absence of exposure to the kidneys.
Today, the following theories have become widespread.
Theory of neurogenic genesis of nephropathy. It implies that this pathology develops under the influence of a violation of the adaptation mechanisms of the higher parts of the nervous system to the restructuring of the body during pregnancy. This fully explains the vascular disorders that characterize nephropathy.
Theory of hormonal genesis of nephropathy. She claims that metabolic products accumulate in the ischemic uterus, which activate the increased production of adrenal hormones. This, in turn, causes the pregnant woman’s kidneys to actively produce the hormone renin, which is also produced outside of them.
Theory of immune genesis of nephropathy. It says that the fetus is perceived by the mother’s body as an alien object, since it has half of the father’s antigens. In this case, the placenta is considered as an immune barrier that slows down the ingress of antigens into the pregnant body. If the placental barrier is broken, immune tolerance decreases: antibodies are produced, and a conflict results. As a result, fibrinoid deposits appear in the capillaries of the kidneys, preventing normal hemostasis.
It is also worth noting that late toxicosis of pregnant women provoke some diseases:
diabetes mellitus;
hypertension;
heart defect;
obesity;
residual effects of pyelonephritis.
If nephropathy of pregnant women is accompanied by these diseases, it is called secondary. Primary nephropathy passes with an unburdened history.
Symptoms of nephropathy
When it comes to a disease such as nephropathy of pregnant women, the symptoms should be classified depending on what degree of pathology is observed.
The first degree of nephropathy of pregnant women:
the volume of edema is small, the location is mainly on the legs;
hypertension — mild (blood pressure below 170/90 mmHg);
proteinuria — functional (up to 1 gram per liter).
The second degree of nephropathy of pregnant women:
the volume of edema is moderate, the location is on the arms, legs and anterior abdominal wall;
hypertension — moderate (blood pressure below 150/100 mmHg);
proteinuria — moderate (up to 3 grams per liter).
The third degree of nephropathy of pregnant women:
the volume of edema is large, the location is all over the body;
hypertension — severe (blood pressure below 180/100 mm Hg);
proteinuria — massive (more than 3 grams per liter).
cylindrical — the appearance of protein casts in the urine;
oliguria is a decrease in the volume of excreted urine.
In addition, a pregnant woman with nephropathy complains of general weakness, intestinal disorders, lower back pain, poor sleep, decreased vision.
If liver damage occurs in parallel, it may manifest as jaundice and pain in the right hypochondrium. If nephropathy of pregnant women has given a complication on the heart, then ischemic myocardiopathy may develop.
Diagnosis of nephropathy of pregnant women
Speaking of diagnostics, first of all it is necessary to determine which doctor should deal with it. Let’s recall the main thing that we already know about such a disease as nephropathy of pregnant women: what it is, how it manifests itself. It can be concluded that the primary diagnosis can be made by both a therapist and a gynecologist observing the patient’s pregnancy.
The reason to draw the doctor’s attention to the possible appearance of nephropathy may be edema. A pregnant woman is able to detect them on her own. They are indicated by the inability to remove the ring from the finger or the feeling that the shoes have become small. In addition, pressing on the inner surface of the lower leg, leaving a trace, also indicates the presence of edema.
In order not to miss the occurrence of late toxicosis in a pregnant woman, you need to carefully monitor the following indicators:
Blood pressure;
body weight (dynamics of weight gain);
indicators of urine analysis;
the volume of fluid excreted from the body through the genitourinary system.
These parameters can be controlled by a therapist. The gynecologist leading a patient with suspected nephropathy is required to carry out the following diagnostic measures:
obstetric ultrasound;
dopplerography of uteroplacental blood flow;
cardiotocography, which allows you to track uterine contractions and fetal heartbeat.
These manipulations make it possible to clarify the condition of the child and the quality of the placenta.
If nephropathy of pregnant women is detected, a woman may also be sent to an ophthalmologist for consultation. This disease in most cases causes hypertensive angiopathy, in which the veins of the fundus dilate, and the arteries, on the contrary, narrow. If you leave this manifestation without attention, there is a risk of minor hemorrhages, retinal edema and even its detachment.
Perhaps the pregnant woman will need a more thorough examination by a nephrologist. Diagnostics will allow you to determine whether a woman has abnormalities of the urinary system. It does not hurt to study the adrenal glands.
Treatment of nephropathy of pregnant women
As already noted, nephropathy requires urgent treatment. Its progression entails such dangerous consequences as:
spontaneous termination of pregnancy;
placental abruption (even if its location is assessed as normal);
hypoxia (oxygen starvation) of the child, which can lead to his death;
uterine bleeding in the mother (both immediately after childbirth and in the early postpartum period).
Such a disease as nephropathy of pregnant women, treatment involves exclusively inpatient. With the first and second degrees of nephropathy, a woman receives a referral to the department of pathology of pregnant women, with the third it is recommended to go to the intensive care unit. Only in a hospital it is possible to closely monitor the work of the kidneys, the dynamics of blood pressure, the content of electrolytes. If the disease is detected at the initial stage, then hospitalization will last no more than ten days.
The main method of combating nephropathy is medication. Therapy sets the following goals:
compensation of protein losses;
normalization of hemodynamics at the macro and micro levels;
removal of angiospasms.
One of the most effective drugs in this case is magnesium sulphate. It is administered intramuscularly in dosages selected according to the degree of nephropathy.
In addition, in the hospital, a pregnant patient should be provided with therapeutic and protective measures, including:
a specially designed diet;
support for optimal rest mode;
provision of bed rest for at least three days;
the appointment of sedatives, including to combat insomnia;
regulation of bowel function.
Discharge from the hospital is possible only with the complete elimination of all signs of nephropathy in a pregnant woman. Upon returning home, a woman should follow the following recommendations:
follow the diet developed by the attending physician;
spend more time in the fresh air to improve blood supply to the placenta;
drink more water;
avoid stress.
It is also worth noting that after the treatment of nephropathy of pregnant women, natural childbirth is possible in most cases. Caesarean section can be prescribed if therapy has not brought the desired result (for example, high blood pressure is maintained), there is a threat of placental abruption or hypoxia.
Prognosis for nephropathy of pregnant women
A timely diagnosis, adequate therapy and strict compliance by the patient with all the doctor’s recommendations make it possible to give a fairly favorable prognosis. If the nephropathy can be cured, the pregnancy persists and ends successfully.
However, the obstetrician should be aware that the woman in labor has suffered nephropathy of pregnant women. In such cases, measures such as:
a special approach to anesthesia;
prevention of hypoxia of the child;
careful monitoring of the condition of the expectant mother.
After delivery, it is recommended that the baby be monitored by a neonatologist. In women, in most cases, the symptoms of nephropathy disappear after childbirth.
As for negative prognoses, they are given when nephropathy manifested itself at an unusually early stage or did not respond to treatment for a long time. Extremely dangerous is the transition of nephropathy of pregnant women into preeclampsia or eclampsia, threatening the life of the mother and child due to damage to the central nervous system and lungs.
Prevention of nephropathy of pregnant women
Minimal preventive measures are careful monitoring of the most important indicators of the pregnant woman’s condition. Medicine has not yet come to a firm conclusion on how to prevent the development of this pathology. Risk factors can be established taking into account the pathogenetic significance of endothelial-platelet abnormalities in a pregnant woman.
If they are detected, the patient can be prescribed small doses of acetylsalicylic acid. In this way, the production of thromboxane in platelets is slowed down, but this will not affect the synthesis of prostacyclin by the vascular endothelium. Basically, such a measure acts on pregnant women with antiphospholipid syndrome.
