Poster Presentation Society of Obstetric Medicine of Australia and New Zealand ASM 2015

Haemodialysis In A Pregnant Patient - A Case Report (#122)

Nargis Noori 1 , Roshini Nayyar 1 , Mirna Vucak-Dzumhur 2
  1. Obstetrics & Gynaecology, Westmead Hospital, Westmead, NSW, Australia
  2. Department of Nephrology, Westmead Hospital, Westmead, NSW, Australia

Introduction: Pregnancy in women with chronic kidney diseasearrow-10x10.png (CKD) is rare with significant maternal and fetal morbidity including anaemia, accelerated hypertension and preeclampsia, poor fetal growth and polyhydramnios4. Maternal factors in CKD that potentially contribute to preterm birth include hypertension, elevated blood urea nitrogen (BUN) and anaemia1. Studies have documented that in women with CKD, BUN levels lower than 50mg/100mL (17.5mmol/L) is associated with increased infant survival3. Polyhydramnios in these patients is also associated with a higher incidence of preterm delivery and is thought to be related to increased maternal urea resulting in fetal solute diuresis2. Improved infant survival in recent years is a result of close obstetric monitoring, advancements in neonatal care and intensified dialysis regimens.

Case: A 30 year old lady presented at 17 weeks gestation with an unremarkable antenatal history and an incidental creatinine of 180umol/L, eGFR 32mL/min/1.73m2 and urea 13mmol/L. She had had one previous uncomplicated normal vaginal delivery at term and an unremarkable medical history. Urine analysis was significant for haematuria and proteinuria. Renal tract ultrasound demonstrated loss of corticomedullary differentiation. A renal biopsy confirmed IgA nephropathy. Terminationarrow-10x10.png of pregnancy was offered but the patient declined. At 22 weeks gestation, the patient’s renal function deteriorated with a creatinine of 192umol/L, eGFR 28mL/min/1.73m2, urea 17mmol/L and 24hour urine protein of 3.5g. At the time she was anaemic with a haemoglobin of 90g/L and had symptomatic polyhydramnios with an amniotic fluid index (AFI) of 30cm. An early glucose tolerance test, TORCH screen and Parvovirus serology was performed to investigate the polyhydramnios which were all negative. She was commenced on weekly erythropoietin and alternate day haemodialysis via a vascath. Her pregnancy was monitored with fortnightly fetal growth ultrasounds and the fetal growth has been within normal limits. The AFI has been monitored and since commencing haemodialysis, has been stable. She had an induction of labour at 35 weeks gestation and continues to be managedarrow-10x10.png with a multi-disciplinary approach.  

  1. Haase M, Morgera S, Bamberg C et al. A systematic approach to managing pregnant dialysis patients – the importance of an intensified haemodiafiltration protocol. Nephrol Dial Transplant 2005; 20: 2537–2542.
  2. Holley JL, Reddy SS. Pregnancy in dialysis patients: a review of outcomes, complications, and management. Semin Dial 2003; 16:398–402.
  3. Reddy SS, Holley JL. Management of the pregnant chronic dialysis patient. Adv Chronic Kidney Dis 2007; 14: 146–155.
  4. Shahir AK, Briggs N, Katsoulis J, Levidiotis, V. An observational outcomes study from 1966–2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology 18 (2013) 276–284