What does the diagnosis of renal failure during pregnancy mean? Possibility of pregnancy with diseased kidneys Complications of renal failure

The amount of work performed by the kidneys is truly enormous. In order not to be unfounded, I will give only a few numbers. The human circulatory system contains about 5.5 liters of blood. At the same time, about 1,700 liters of blood passes through the kidneys of an adult every day (about a quarter of the blood passing through the heart)! It turns out that every drop of blood passes through the kidneys almost 500 times a day, and each time its composition is controlled and changed. Every day, 1-1.5 liters of urine are produced in the kidneys. Urine is approximately 96% water; the remaining 4% are various (mostly toxic) salts and metabolic products. Healthy kidneys are the body’s main shield against toxins.

However, the mission of this body is by no means limited to “cleaning” functions. It is neither possible nor necessary to list all the functions of the kidneys here. Let's just say that the kidneys actively participate in the regulation of blood pressure, producing a special substance - renin, which, when released into the blood, triggers a chain of reactions that ultimately increase blood pressure.

During pregnancy, the task of the kidneys becomes much more complicated. Why? It’s simple: to the “standard” load, so to speak, is added the need to process and remove from the mother’s body waste products of the fetus that enter the mother’s blood through the placenta.

Due to the enormous increase in load on the kidneys, pregnancy itself seriously increases the risk of developing diseases of this organ. And of course, this danger increases many times if, even before conception, the woman had any problems with the functioning of the urinary organs. Therefore, before planning a child, it is very important to evaluate the condition of the kidneys with the help of a doctor. There are kidney diseases in which the birth of a child is possible with appropriate treatment and pregnancy management. However, unfortunately, there are also such serious changes in kidney function that pregnancy becomes an unbearable burden for them. The inability to bear and give birth to a healthy child is one of the most terrible medical “sentences” for most women. However, the consequences of pregnancy in some (not all!) kidney diseases are so formidable that upon mature reflection, any woman will understand: medical contraindications are not the whim of doctors and not reinsurance. Knowledge, even bitter knowledge, is always better than ignorance. Having survived the first shock, the family can radically rebuild their lives. Many spouses decide to adopt - and, if the decision was made with full awareness of the responsibility of this step, they fully acquire the joy of motherhood and fatherhood, and there is one less unfortunate child on earth...

Today, medicine has the means to treat many kidney diseases in pregnant women. The basis of treatment is antibacterial therapy, individually prescribed by a doctor. It is the doctor who must decide what can help the woman in each individual case and not harm the child.

One of the most common kidney diseases is pyelonephritis 1. Pregnancy with pyelonephritis, as a rule, can be saved. However, I want to warn those who have pyelonephritis accompanied (arterial hypertension, or hypertension) or kidney failure(uremia). Unfortunately, they pregnancy is contraindicated 2 .

Treatment of acute pyelonephritis is mandatory: infection is much more dangerous for the fetus than medications. Patients - especially during an exacerbation of the disease - need to drink more (water, fruit drinks, juices, milk, tea, compotes - at least two liters of liquid per day). The liquid helps remove microbes, purulent secretions and salts from the body.

If drug therapy for purulent pyelonephritis is ineffective, surgical treatment is used. At the same time, they try to preserve the pregnancy. It is important to know that termination of pregnancy does not eliminate the inflammatory process in the kidney and cannot replace surgery.

The most dangerous complications are caused by glomerulonephritis 3 , although they suffer from it much less often than pyelonephritis. Acute glomerulonephritis, as well as exacerbation of chronic, considered a contraindication for pregnancy due to the fact that in these cases long-term treatment is required with the use of drugs that have a detrimental effect on the fetus. Chronic glomerulonephritis can occur in different forms. The most severe and life-threatening complications for the woman and the fetus occur in those forms of the disease that are accompanied by high blood pressure, and in any form leading to uremia(i.e. to self-poisoning of the body due to renal failure). In these cases pregnancy is absolutely contraindicated, it should be interrupted at any time, since it is fraught with the most tragic consequences.

At the same time, clinical observations show that serious complications do not occur in all patients with glomerulonephritis.

With the so-called nephrotic form of glomerulonephritis, For example, pregnancy and childbirth are possible, if there are conditions for long-term treatment and observation of the patient in a hospital. However, you should prepare yourself in advance for the fact that pregnancy may be difficult, and the child may experience malnutrition (weight deficiency with normal growth).

Acceptable pregnancy and at latent(i.e. hidden) form of chronic glomerulonephritis. Edema and high blood pressure are usually not observed in such patients. Only changes in urine are noted. And although complications during pregnancy still occur more often than in healthy women, in most cases the pregnancy ends well for both the mother and the fetus. 65% of cases of glomerulonephritis in pregnant women are latent.

Diet is important for patients with glomerulonephritis. It is different for different forms of this disease. And only in the latent form, the diet is no different from the one recommended for healthy pregnant women.

Urolithiasis disease, as a rule, does not occur in pregnant women, but an exacerbation of a latent disease is possible. Urolithiasis itself does not have a significant effect on the course of pregnancy and fetal development, but, unfortunately, in approximately a third of patients it is complicated by pyelonephritis, so pregnant women with urolithiasis need very close medical supervision. Urolithiasis is not a reason to terminate pregnancy. Patients are prescribed a diet depending on the individual type of mineral metabolism disorder. If renal colic occurs, you should definitely call an ambulance. Before the doctor arrives, take 1-2 tablets of papaverine, no-shpa, or baralgin. (Promedol, morphine are not recommended due to the negative effect on the fetus.) A hot bath or heating pads on the kidney area are contraindicated: they can cause a miscarriage. If possible, refrain from surgical treatment of urolithiasis, resorting to it only for emergency indications 4 . In case of forced surgical intervention, doctors try to preserve the pregnancy.

Some women have congenital disorders of the structure of the urinary organs 5.Anomalies in the development of the urinary tract can provoke the appearance of pyelonephritis, high blood pressure, and worsen kidney function during pregnancy. That's why the question of whether to give birth or not to give birth is decided after a thorough examination of the woman. The examination also allows you to identify risk factors in advance: infection, high blood pressure, decreased kidney function. Many women with structural anomalies of the kidneys and urinary tract have to undergo a caesarean section 6 . Surgical correction of abnormal development of the urinary organs in pregnant women is usually not performed, limiting itself to symptomatic drug therapy.

Hydronephrosis (dropsy of the kidneys) It can be congenital or acquired as a result of a violation of the outflow of urine from the kidney, when the ureter is compressed by a stone, tumor, or has a bend. During pregnancy, the obstruction of urine outflow often intensifies and hydronephrosis progresses. Against this background, almost all pregnant women develop pyelonephritis. Possible chronic renal failure 7 . In such cases, pregnancy is contraindicated. The doctor must warn the patient about this.

Absence of one kidney may be congenital (aplasia) or a consequence of surgical removal of the kidney (nephrectomy).

In the congenital absence of one kidney, the obstetric prognosis is worse than in cases where the second kidney is surgically removed. After all, a single kidney can be infected or functionally defective even if no abnormalities were observed before pregnancy. Therefore, women with renal aplasia are examined as carefully as with other anomalies of the development of the urinary organs.

The kidney remaining as a result of surgical removal can completely compensate for the function of the lost organ. But this takes 1.5-2 years after the operation. Pregnancy that occurs before this period may result in miscarriage.

If, after surgery to remove a kidney, the remaining kidney is healthy, the pregnancy usually proceeds well. In cases where the only kidney is infected, the prognosis is much worse. If the need to remove the kidney was due to a tumor, pregnancy is permissible only in cases where more than 5 years have passed since the operation and there has been no recurrence of the tumor.

Narrowing of the renal artery causes persistently high blood pressure - the so-called renovascular hypertension. Pregnancy with this disease is associated with serious danger to the fetus. Such a woman can become a mother only if she had a diseased kidney removed a year or more before pregnancy.

So, all women with one kidney must undergo a thorough medical examination before the question of whether they are pregnant is decided. 8 .

Women suffering from kidney disease, in which pregnancy is contraindicated, must be protected. To do this, you should use mechanical means of protection (condom, diaphragm), intrauterine devices, but not hormonal contraceptive pills. Hormonal contraceptives affect the blood clotting process, support inflammation in the kidney tissue, increase blood pressure and thereby aggravate the course of the disease.

It may seem that all these sad things were said in order to intimidate pregnant women and women planning pregnancy. Not at all. My main goal is to bring to their consciousness an indisputable, but not obvious truth to everyone: kidneys are very serious . The degree of responsibility of a woman planning to give birth to a child, as they say, “is difficult to overestimate,” therefore:

Even if you have never suffered from nephrological diseases or have been ill for a long time and are sure that the disease has passed without a trace, planning a pregnancy or learning about it, be sure to check your kidneys. (Most often, a urine test is sufficient; however, your doctor will give you any instructions you need.)

If your kidneys are not in order, but doctors believe that pregnancy is possible, be very careful and strictly follow all instructions of specialists: the life and health of your future baby depends on this, and your life and health too.

If doctors categorically declare that pregnancy is impossible, they probably have the most compelling reasons for this. Don't risk yourself or your unborn child.– direct all your efforts to build your life based on the inability to bear and give birth to a child. (Remember: this does not mean that you cannot raise and raise a child!)

1 Pyelonephritis is inflammation of the kidney and renal pelvis. Under unfavorable conditions and lack of medical supervision, pyelonephritis can cause miscarriage, premature birth, hypoxia (lack of oxygen) and malnutrition (lack of body weight from growth) of the fetus, its death during pregnancy and childbirth. The fact is that the uterus, which grows during pregnancy, compresses the urinary tract, complicating the outflow of fluid from the renal pelvis. The natural direction of urine movement changes, it is thrown from the underlying parts of the urinary tract to the overlying ones (so-called reflux). All this contributes to the exacerbation of the disease and can even cause pyelonephritis in a woman who has not previously been ill.

2 Due to impaired renal function in renal failure, toxic metabolic products accumulate in the body, which are deadly for both the mother and the fetus.

3 Glomerulonephritis is an inflammatory disease of the so-called “glomerular apparatus” of the kidneys, caused by one of the types of pathogenic (i.e., pathogenic) bacteria, streptococci.

4 When urine production stops, sepsis (blood poisoning) begins as a result of pyelonephritis or attacks of renal colic often recur.

5 Most often this is a duplication of the kidneys, pelvis and ureters, often polycystic kidneys, their prolapse or fusion.

6 The need for a caesarean section occurs when the kidney descends into the pelvic area, when the kidneys are fused (“horseshoe kidney”), after plastic surgery to restore the missing bladder wall, when placental abruption occurs due to high blood pressure, fetal hypoxia and in some other cases .

Modern medicine manages to cope with most acute kidney diseases and curb the progression of most chronic ones. Unfortunately, until now, about 40% of renal pathologies are complicated by the development of chronic renal failure (CRF).

This term means the death or replacement by connective tissue of part of the structural units of the kidneys (nephrons) and irreversible impairment of the kidneys’ functions to cleanse the blood of nitrogenous wastes, produce erythropoietin, which is responsible for the formation of red blood elements, remove excess water and salts, and reabsorb electrolytes.

The consequence of chronic renal failure is a disorder of water, electrolyte, nitrogen, acid-base balance, which entails irreversible changes in the state of health and often becomes the cause of death in terminal chronic renal failure. The diagnosis is made when disorders are registered for three months or longer.

Today, CKD is also called chronic kidney disease (CKD). This term emphasizes the potential for the development of severe forms of renal failure even in the initial stages of the process, when the glomerular filtration rate (GFR) has not yet been reduced. This allows for more careful attention to patients with asymptomatic forms of renal failure and improves their prognosis.

Criteria for chronic renal failure

The diagnosis of chronic renal failure is made if the patient has one of two types of renal disorders for 3 months or more:

• Damage to the kidneys with disruption of their structure and function, which are determined by laboratory or instrumental diagnostic methods. In this case, GFR may decrease or remain normal.
• There is a decrease in GFR of less than 60 ml per minute in combination with or without kidney damage. This rate of filtration corresponds to the death of about half of the nephrons of the kidneys.

What leads to chronic renal failure

Almost any chronic kidney disease without treatment can sooner or later lead to nephrosclerosis with the failure of the kidneys to function normally. That is, without timely treatment, such an outcome of any kidney disease such as chronic renal failure is just a matter of time. However, cardiovascular pathologies, endocrine diseases, and systemic diseases can lead to renal failure.

• Kidney diseases: chronic glomerulonephritis, chronic tubulointerstitial nephritis, renal tuberculosis, hydronephrosis, polycystic kidney disease, nephrolithiasis.
• Pathologies of the urinary tract: urolithiasis, urethral strictures.
• Cardiovascular diseases: arterial hypertension, atherosclerosis, incl. angiosclerosis of the renal vessels.
• Endocrine pathologies: diabetes.
• Systemic diseases: renal amyloidosis, .

How does chronic renal failure develop?

The process of replacing the affected glomeruli of the kidney with scar tissue is simultaneously accompanied by functional compensatory changes in the remaining ones. Therefore, chronic renal failure develops gradually, passing through several stages in its course. The main reason for pathological changes in the body is a decrease in the rate of blood filtration in the glomerulus. The normal glomerular filtration rate is 100-120 ml per minute. An indirect indicator by which one can judge GFR is blood creatinine.

• The first stage of chronic renal failure is initial

At the same time, the glomerular filtration rate remains at the level of 90 ml per minute (normal variant). There is confirmed kidney damage.

• Second stage

It suggests kidney damage with a slight decrease in GFR in the range of 89-60. For older people, in the absence of structural damage to the kidneys, such indicators are considered normal.

• Third stage

In the third moderate stage, GFR drops to 60-30 ml per minute. At the same time, the process occurring in the kidneys is often hidden from view. There is no bright clinic. There may be an increase in the volume of urine excreted, a moderate decrease in the number of red blood cells and hemoglobin (anemia) and associated weakness, lethargy, decreased performance, pale skin and mucous membranes, brittle nails, hair loss, dry skin, decreased appetite. About half of the patients experience an increase in blood pressure (mainly diastolic, i.e. lower).

• Fourth stage

It is called conservative because it can be controlled by medications and, like the first, does not require blood purification using hardware methods (hemodialysis). At the same time, glomerular filtration is maintained at a level of 15-29 ml per minute. Clinical signs of renal failure appear: severe weakness, decreased ability to work due to anemia. The volume of urine excreted increases, significant urination at night with frequent urges at night (nocturia). Approximately half of patients suffer from high blood pressure.

• Fifth stage

The fifth stage of renal failure is called terminal, i.e. final. When glomerular filtration decreases below 15 ml per minute, the amount of urine excreted drops (oliguria) until it is completely absent in the outcome of the condition (anuria). All signs of poisoning of the body with nitrogenous wastes (uremia) appear against the background of water-electrolyte imbalance, damage to all organs and systems (primarily the nervous system, heart muscle). With this development of events, the patient’s life directly depends on blood dialysis (cleaning it bypassing non-functioning kidneys). Without hemodialysis or kidney transplantation, patients die.

Symptoms of chronic renal failure

Appearance of patients

The appearance does not suffer until the stage when glomerular filtration is significantly reduced.

• Due to anemia, pallor appears, due to water and electrolyte disturbances, dry skin.
• As the process progresses, yellowness of the skin and mucous membranes appears and their elasticity decreases.
• Spontaneous bleeding and bruising may occur.
• This causes scratching.
• Characterized by so-called renal edema with puffiness of the face, up to the common type of anasarca.
• The muscles also lose tone and become flabby, which causes fatigue to increase and the ability of patients to work decreases.

Nervous system lesions

This is manifested by apathy, night sleep disorders and daytime sleepiness. Decreased memory and learning ability. As chronic renal failure increases, severe inhibition and disturbances in the ability to remember and think appear.

Disturbances in the peripheral part of the nervous system affect the limbs with chilliness, tingling sensations, and crawling sensations. Later, movement disorders in the arms and legs develop.

Urinary function

She first suffers from polyuria (increased urine volume) with a predominance of nighttime urination. Further, chronic renal failure develops along the path of a decrease in urine volume and the development of edematous syndrome until the complete absence of excretion.

Water-salt balance

• salt imbalance manifests itself as increased thirst, dry mouth
• weakness, darkening of the eyes when standing up suddenly (due to sodium loss)
• Excess potassium may cause muscle paralysis
• breathing problems
• slowing of heartbeats, arrhythmias, intracardiac blockades up to cardiac arrest.

Against the background of increased production of parathyroid hormone by the parathyroid glands, high levels of phosphorus and low levels of calcium appear in the blood. This leads to softening of the bones, spontaneous fractures, and itchy skin.

Nitrogen balance disorders

They cause an increase in blood creatinine, uric acid and urea, resulting in:

• when GFR is less than 40 ml per minute, enterocolitis develops (damage to the small and large intestines with pain, bloating, frequent loose stools)
• ammonia odor from the mouth
• secondary articular lesions such as gout.

The cardiovascular system

• firstly, it responds by increasing blood pressure
• secondly, damage to the heart (muscles - pericarditis, pericarditis)
• Dull pain in the heart, heart rhythm disturbances, shortness of breath, swelling in the legs, and enlarged liver appear.
• If myocarditis progresses unfavorably, the patient may die due to acute heart failure.
• pericarditis can occur with the accumulation of fluid in the pericardial sac or the loss of uric acid crystals in it, which, in addition to pain and expansion of the boundaries of the heart, when listening to the chest, gives a characteristic (“funeral”) pericardial friction noise.

Hematopoiesis

Against the background of a deficiency in the production of erythropoietin by the kidneys, hematopoiesis slows down. The result is anemia, which manifests itself very early in weakness, lethargy, and decreased performance.

Pulmonary complications

characteristic of late stages of chronic renal failure. This is uremic lung - interstitial edema and bacterial inflammation of the lung against the background of a decrease in immune defense.

Digestive system

She reacts with decreased appetite, nausea, vomiting, inflammation of the oral mucosa and salivary glands. With uremia, erosive and ulcerative defects of the stomach and intestines appear, fraught with bleeding. Acute hepatitis is a frequent accompaniment of uremia.

Kidney failure during pregnancy

Even a physiologically occurring pregnancy significantly increases the load on the kidneys. In chronic kidney disease, pregnancy aggravates the course of the pathology and can contribute to its rapid progression. This is due to the fact that:

• during pregnancy, increased renal blood flow stimulates overstrain of the renal glomeruli and the death of some of them,
• deterioration of conditions for reabsorption of salts in the renal tubules leads to losses of high volumes of protein, which is toxic to renal tissue,
• increased functioning of the blood coagulation system contributes to the formation of small blood clots in the capillaries of the kidneys,
• worsening arterial hypertension during pregnancy contributes to glomerular necrosis.

The worse the filtration in the kidneys and the higher the creatinine numbers, the more unfavorable the conditions for pregnancy and its gestation. A pregnant woman with chronic renal failure and her fetus face a number of pregnancy complications:

• Arterial hypertension
• Nephrotic syndrome with edema
• Preeclampsia and eclampsia
• Severe anemia
• and fetal hypoxia
• Delays and malformations of the fetus
• and premature birth
• Infectious diseases of the urinary system of a pregnant woman

To resolve the issue of the advisability of pregnancy for each specific patient with chronic renal failure, nephrologists and obstetricians-gynecologists are involved. In this case, it is necessary to assess the risks for the patient and the fetus and correlate them with the risks that the progression of chronic renal failure every year reduces the likelihood of a new pregnancy and its successful resolution.

Treatment methods

The beginning of the fight against chronic renal failure is always the regulation of diet and water-salt balance

• Patients are recommended to eat a diet limiting their protein intake to 60 grams per day and predominantly consuming plant proteins. As chronic renal failure progresses to stages 3-5, protein is limited to 40-30 g per day. At the same time, the proportion of animal proteins is slightly increased, giving preference to beef, eggs and lean fish. The egg-potato diet is popular.
• At the same time, the consumption of foods containing phosphorus (legumes, mushrooms, milk, white bread, nuts, cocoa, rice) is limited.
• Excess potassium requires reducing the consumption of black bread, potatoes, bananas, dates, raisins, parsley, figs).
• Patients have to manage with a drinking regimen of 2-2.5 liters per day (including soup and taking pills) in the presence of severe edema or intractable arterial hypertension.
• It is useful to keep a food diary, which makes it easier to track the protein and microelements in food.
• Sometimes specialized mixtures, enriched with fats and containing a fixed amount of soy proteins and balanced in microelements, are introduced into the diet.
• Along with the diet, patients may be prescribed an amino acid substitute - Ketosteril, which is usually added when GFR is less than 25 ml per minute.
• A low-protein diet is not indicated for exhaustion, infectious complications of chronic renal failure, uncontrolled arterial hypertension, with GFR less than 5 ml per minute, increased protein breakdown, after surgery, severe nephrotic syndrome, terminal uremia with damage to the heart and nervous system, and poor diet tolerance.
• Salt is not limited to patients without severe arterial hypertension and edema. In the presence of these syndromes, salt is limited to 3-5 grams per day.

Enterosorbents

They can somewhat reduce the severity of uremia by binding in the intestines and removing nitrogenous wastes. This works in the early stages of chronic renal failure with relative preservation of glomerular filtration. Polyphepan, Enterodes, Enterosgel, Activated carbon, are used.

Treatment of anemia

To relieve anemia, Erythropoietin is administered, which stimulates the production of red blood cells. Uncontrolled arterial hypertension becomes a limitation to its use. Since iron deficiency may occur during treatment with erythropoietin (especially in menstruating women), therapy is supplemented with oral iron supplements (Sorbifer Durules, Maltofer, etc., see).

Bleeding disorder

Correction of blood clotting disorders is carried out with Clopidogrel. Ticlopedin, Aspirin.

Treatment of arterial hypertension

Drugs for the treatment of arterial hypertension: ACE inhibitors (Ramipril, Enalapril, Lisinopril) and sartans (Valsartan, Candesartan, Losartan, Eprosartan, Telmisartan), as well as Moxonidine, Felodipine, Diltiazem. in combinations with saluretics (Indapamide, Arifon, Furosemide, Bumetanide).

Phosphorus and calcium metabolism disorders

It is stopped with calcium carbonate, which prevents the absorption of phosphorus. Lack of calcium - synthetic vitamin D preparations.

Correction of water and electrolyte disorders

is carried out in the same way as the treatment of acute renal failure. The main thing is to relieve the patient from dehydration due to restrictions in the diet of water and sodium, as well as eliminating blood acidification, which is fraught with severe shortness of breath and weakness. Solutions with bicarbonates and citrates, sodium bicarbonate are introduced. A 5% glucose solution and Trisamine are also used.

Secondary infections in chronic renal failure

This requires the prescription of antibiotics, antiviral or antifungal drugs.

Hemodialysis

With a critical decrease in glomerular filtration, blood purification from substances of nitrogen metabolism is carried out by hemodialysis, when waste products pass into the dialysis solution through a membrane. The most commonly used device is an “artificial kidney”; less commonly, peritoneal dialysis is performed, when the solution is poured into the abdominal cavity, and the peritoneum plays the role of a membrane. Hemodialysis for chronic renal failure is carried out in a chronic mode. For this, patients travel for several hours a day to a specialized center or hospital. In this case, it is important to timely prepare an arteriovenous shunt, which is prepared at a GFR of 30-15 ml per minute. From the moment the GFR drops below 15 ml, dialysis begins in children and patients with diabetes mellitus; with GFR less than 10 ml per minute, dialysis is carried out in other patients. In addition, indications for hemodialysis will be:

• Severe intoxication with nitrogenous products: nausea, vomiting, enterocolitis, unstable blood pressure.
• Treatment-resistant edema and electrolyte disturbances. Cerebral edema or pulmonary edema.
• Severe acidification of the blood.

Contraindications to hemodialysis:

• bleeding disorders
• persistent severe hypotension
• tumors with metastases
• decompensation of cardiovascular diseases
• active infectious inflammation
• mental illness.

Kidney transplant

This is a radical solution to the problem of chronic kidney disease. After this, the patient has to use cytostatics and hormones for life. There are cases of repeated transplants if for some reason the graft is rejected. Renal failure during pregnancy with a transplanted kidney is not an indication for termination of pregnancy. pregnancy can be carried to the required term and is usually resolved by cesarean section at 35-37 weeks.

Thus, Chronic kidney disease, which today has replaced the concept of “chronic renal failure,” allows doctors to see the problem in a more timely manner (often when there are still no external symptoms) and respond by starting therapy. Adequate treatment can prolong or even save the patient’s life, improve his prognosis and quality of life.

The kidney is a paired organ in the excretory system, primarily involved in filtering harmful substances in the urine. Kidney failure during pregnancy can develop due to an increase in the size of the female reproductive organs. Enlarged organs can put pressure on the ureters, kidney tissue or arteries, which impairs the functioning of the kidneys, but these are not the only reasons for the development of the disease. When the kidneys fail, disturbances in the filtration and excretion of urine are observed, followed by intoxication of the body. Kidney failure during pregnancy requires immediate medical attention.

Pregnancy and chronic renal failure

Pregnancy with chronic renal failure is quite difficult. The frequency of birth complications is observed in comparison with the rate in women who do not have the disease. Complications can cause premature birth. There is a need for a caesarean section and intensive care for the newborn. However, thanks to the development of medicine, 9 out of 10 pregnant women have the opportunity to carry and give birth to a child normally. The examinations were carried out in women with moderate pathology.

In severe cases of the disease, pregnancy and childbirth have less chance of a successful outcome. If pregnancy with renal failure is accompanied by increased pressure in hollow organs, vessels or body cavities, the risk of miscarriage, stillbirth, fetal death inside the womb, premature birth, large blood loss during childbirth, and impaired development in the newborn increases.

Acute renal failure, causes of its development

All causes leading to impaired renal function can be divided into renal and extrarenal.

In acute renal failure, an increased amount of urea and uric acid in the body is observed. These chemical components destroy the body and pose a threat to the life of mother and child. The development of acute renal failure most often occurs in the first or last trimester. The main reasons for the development of the disease are associated with other disorders in the body.

• abortion under unsterile conditions;
• postpartum hemorrhage;
• cervical cancer;
• uterine cancer;
• ovarian cancer;
• late pregnancy termination;
• poisoning during pregnancy with drugs;
• toxicosis during pregnancy;
• pyelonephritis before pregnancy;
• blood transfusion with another Rh factor;
• injury;
• severe increase in body weight;
• cystitis;
• stones in the kidneys;
• thrush;
• long stay of a dead fetus in the uterus.

Forms of acute renal failure

The course of the disease depends on the form of renal failure.

The following types of surge arresters are distinguished:

• prerenal form;
• renal form;
• postrenal form.

The prerenal form occurs due to poor circulation in the kidneys. If the patient receives help within 2 hours, the full functioning of the kidneys quickly resumes. The renal form develops due to damage to organ cells and their dysfunction. Damage can be caused by surgery, antibiotics, and heavy metal poisoning. Timely treatment can partially or completely reverse further damage to kidney cells. The postrenal form develops due to diseases that block the urinary ducts, such as stones. The disease causes lower back pain, possible development of infections or transition to the prerenal or renal form of the disease.

Symptoms of the disease in chronic and acute renal failure

List of dangerous symptoms:

• complete cessation of urine output;
• decrease in daily urine output;
• nagging pain in the lower back and kidney area;
• dark coffee-colored urine;
• urine with blood pigments;
• increased amount of protein in urine;
• vomit;
• state of shock;
• increased body temperature;
• increased blood pressure;
• high concentrations of potassium and nitrogen in the blood;
• muscle weakness;
• disturbance of heart rhythms;
• pale skin and possible yellowness of mucous membranes;
• increased thirst and dry mouth;
• strong smell of urine;
• increased acidity of blood and urine.

In case of acute renal failure, a pregnant woman should be observed by a gynecologist.

If you have the symptoms described above, you should immediately consult a gynecologist. Severe kidney failure can be fatal for both mother and baby. With timely treatment, kidney function can be completely restored and pregnancy can be maintained. If you do not contact a specialist in time, new symptoms appear, such as bloody feces, numbness of the limbs, and convulsions.

Course of the disease and possible complications

Even a healthy pregnancy increases the load on all organs and systems, including the kidneys. During pregnancy with renal failure, the entire excretory system and other organs are overstrained due to intoxication of the body with toxic products that are not filtered by the kidneys. Possible complications:

• formation of blood clots in the capillaries of the kidneys;
• chronic blood pressure;
• swelling due to kidney damage;
• development of anemia;
• intrauterine oxygen starvation;
• chronic renal failure;
• renal coma;
• sepsis;
• death if the disease cannot be treated;
• infectious diseases in the genitourinary system.

Diagnosis of the disease

Based on clinical and biochemical tests of blood and urine, the doctor makes a diagnosis.

To make a diagnosis, the patient must undergo a general blood test, a general urinalysis, a biochemical blood test and a microbiological examination of urine. Additionally, you will need to undergo an ultrasound examination of the bladder. For a complete examination, it is recommended to undergo magnetic resonance imaging.

Women's health is a complex mechanism in which failure occurs at the slightest influence of external and internal factors. Kidney failure during pregnancy weakens the already overloaded body, causing intoxication and affecting the development of the fetus. Therefore, when the first signs appear, you should immediately contact a specialist who will conduct a diagnostic complex and prescribe appropriate treatment.

The presence of renal failure during pregnancy poses a great threat to the health of the mother and fetus.

Chronic renal failure during pregnancy

With this type of pathology, the process of bearing a child is difficult for a woman, and complications develop with double the frequency. This condition can trigger preterm labor, which will require a cesarean section. Subsequently, the baby will have to undergo intensive therapy to maintain his health. Pregnancy with chronic renal failure (CRF) goes smoothly if the form of the deviation is not complex. Otherwise, a miscarriage may occur, premature labor and large blood loss may develop during childbirth.

Acute renal failure and features of its development

There is a sharp increase in the amount of urea and uric acid, which can harm the life of not only the fetus, but also the mother. In the first and last trimester, the body is most susceptible to complications. Acute renal failure during pregnancy (ARF) can be caused by the following factors:

• not sterile abortion;
• postpartum blood loss;
• long-term pregnancy failure;
• intoxication during pregnancy with pharmaceuticals;
• toxicosis;
• inflammation of the kidneys before conceiving a child;
• blood transfusion with another Rh factor;
• traumatic influence;
• a sharp jump in weight;
• inflammation of the bladder;
• stones in the bean-shaped organ of the genitourinary system;
• thrush.

What forms of development of pathology exist?

Kidney failure during pregnancy develops due to pathologies in the organ or neighboring systems.

There are several types of acute renal failure:

• Oral. Caused by poor blood flow in the kidneys. To fully restore renal function, assistance should be provided in the first few hours.
• Renal. It develops under the influence of pathogenic processes that occur in the cells of the organ. Timely measures taken will help stop the destructive process.
• Postrenal. The root cause of development is pathology of the urinary tract. It manifests itself as pain in the lumbar region, and in advanced cases it develops into two other forms.

Characteristic symptoms for chronic renal failure and acute renal failure

Acute and chronic renal failure during pregnancy is accompanied by:

• complete cessation of urine production;
• reduction in urine production per day;
• nagging pain in the lumbar region;
• dark brown urine with bloody discharge;
• increased amount of protein in the urine;
• increased body temperature;
• increased blood pressure;
• high concentration of potassium and magnesium;
• disturbance of heart rhythms.

How high is the risk of complications?

Pregnancy always puts a strain on the excretory system, and with renal failure, poisoning of the body develops due to a weakening of the filtration capacity. Side effects include:

• formed blood clots in the renal capillaries;
• persistently elevated blood pressure;
• swelling;
• anemia;
• oxygen starvation in the womb;
• renal coma;
• death;
• pathologies of the genitourinary system of an infectious nature.

Kidney failure is a serious pathology that can affect the general condition of a woman and the development of the fetus. As a rule, 20% of women with a similar diagnosis experience pregnancy complications after the second trimester and in postpartum recovery. Pregnancy does not aggravate the pathogenesis of infectious renal diseases, however, complications can occur with uncontrolled hypertension. In this article we will tell you how kidney failure during pregnancy affects the body of the woman and the fetus. Let's look at the symptoms and treatment methods.

Characteristics of the disease

Kidney failure has a negative impact on the body, namely, with this diagnosis, the ability of the kidneys to normally produce and excrete urine, as well as remove excess and toxic substances from the body, is lost. Depending on the form of the pathology, this ability may be lost or partially impaired, which entails complex and negative consequences for health. Violation of nitrogen, water and other important internal metabolisms leads to the failure of vital systems, and as a result, the patient’s health deteriorates significantly. In medicine, this pathology is divided into two types:

• Acute form - manifests itself as a result of severe burns, fractures, hemorrhagic shock, toxic effects of poisons and harmful substances, disruption of the ureteric canals, infectious kidney diseases pyelonephritis and nephritis. A sharp deterioration in kidney function, resulting in complete or partial disruption of nitrogen metabolism.
• Chronic form- manifests itself as a result of previous kidney diseases and nephron death. The pathology is characterized by deterioration in functionality, performance and general condition of the entire renal system and health.

The diagnosis of chronic renal failure is established provided that the patient has had the following kidney and system disorders for more than three months:

• damage to an organ with impaired functionality, structure, deviation is determined by diagnosis;
• the filtration rate decreases to a level of 60 ml per 1 minute in combination with and without kidneys.

Forms of acute kidney pathology

• perenal form- formed as a result of circulatory disorders in the kidneys; with timely assistance to the patient, kidney function is restored and begins to work as usual;
• renal form- formed as a result of damage to organ cells and their dysfunction; antibiotics and intoxication with heavy metals can provoke their damage;
• post-acute form- formed as a result of various diseases that block the urinary system or stones.

Causes of chronic renal failure

Chronic renal failure is a rather complex form of kidney disease, which requires constant treatment and a number of preventive measures to prevent negative consequences. If you ignore the recommendations of your doctor and do not follow therapy, chronic renal failure develops into kidney failure and nephrosclerosis. The reasons why chronic renal failure occurs:

• kidney pathology: chronic glomerulonephritis and pyelonephritis, kidney tuberculosis, polycystic kidney disease, organ cancer and nephrlithiasis;
• diseases of the urinary tract:
• urethral stricture, urolithiasis;
• cardiovascular diseases: atherosclerosis, arterial hypertension, angiosclerosis of renal vessels;
• endocrine diseases: diabetes, thyroid problems;
• systemic pathologies: hemorrhagic vasculitis, renal amyloidosis.

Symptoms of kidney disease

The stage of renal failure, symptoms and general condition directly depend on the nature and morphology of the disease. The first symptoms of the disease appear in anemia, the chemical content of nitrogen and potassium substances, as well as an increase or decrease in the volume of urination per day. The symptoms of the pathology are as follows:

• Changes in appearance due to impaired glomerular filtration; due to anemia, the skin color changes, it becomes pale and painful, dryness appears, and elasticity decreases. Spontaneous hemorrhages and itching may also appear. Due to impaired renal function, swelling, puffiness appears, muscle mass loses its elasticity and becomes flabby;
• Nervous system disorder. This symptom manifests itself in sleep disturbances, the appearance of apathy, memory deterioration, and the formation of limb disorders;
• A violation of the urinary system manifests itself in the form of a sharp increase in the volume of urine, over time the volume decreases and may disappear altogether;
• An imbalance in the water-salt balance in the body manifests itself in constant thirst, dry mouth, breathing is impaired, arrhythmia appears, the heartbeat quickens, the patient feels unwell and weak;
• An increased level of parathyroid hormone production, as a result of which the level of phosphorus prevails over calcium in the blood, where softening of bone tissue and the formation of fractures occurs;
• Violation of the nitrogen balance leads to the formation of an ammonia taste in the mouth, affecting the small and large intestines with severe pain attacks;
• A disorder of the cardiovascular system manifests itself in the form of an increase in blood pressure, damage to the heart, heart rate, shortness of breath, swelling of the extremities, the liver increases in size, acute heart failure and death may occur;
• A disorder of the blood system manifests itself in insufficient production of erythropoietin by the kidneys.

Disturbance of the digestive system manifests itself in the form of decreased appetite, attacks of nausea and severe vomiting, and inflammation of the salivary glands.

Pregnancy and kidney pathology

Kidney failure and pregnancy significantly increases the load on a woman’s entire renal system. In chronic renal failure, pregnancy significantly worsens the morphology of the disease and entails its progression. Causes of complications:

• during pregnancy, strong blood flow increases and stimulates the tension of the renal tangles, some of which die;
• the process of normal absorption of salt by the renal tubules is disrupted, as a result of which the protein breaks down in large volumes, and its particles are toxic to the kidney tissue;
• due to increased work of the blood coagulation system, small blood clots are formed in the renal capillaries;
• Arterial hypertension increases, resulting in kidney necrosis.

During the period of deterioration in the filtration process by the kidneys, the level of creatinine increases, which complicates the conditions and course of pregnancy, and the gestation of the fetus becomes unfavorable. Complications of chronic renal failure for a pregnant woman:

• nephrotic syndrome with the formation of severe swelling;
• arterial hypertension;
• complex form of anemia;
• delay and defects in fetal development;
• inability to bear a fetus, premature birth;
• infectious pathologies of the urinary system.

Treatment method for disease during pregnancy

To prevent the formation of negative consequences and eliminate complications of renal failure in pregnant women, do the following:

• eliminate ectopic bleeding and hemodynamic disorders;
• with a normal gestational age, rapid delivery is performed to avoid stillbirth and fetal growth arrest;
• during the period of perenal acute renal failure, the intravascular volume of fluid should be restored, restoration is carried out by introducing a zotonic solution of sodium chloride;
• treatment of acute tubular necrosis is aimed at eliminating ischemia and infection, maintaining fluid balance and restoring blood supply to the organ;
• the early stage of cortical necrosis is eliminated with anticoagulant therapy; if there is no result, hemodialysis is used;
• During the development of obstructive acute renal failure, detoxification and antibacterial therapy is performed.

Kidney failure and pregnancy are a complex process that requires constant monitoring and supervision by specialists. With timely observation by specialists and implementation of recommendations, a positive result in bearing a fetus is possible.