Pregnancy in end-stage renal disease patients on hemodialysis: two case reports

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Abstract

Introduction

Pregnancy in patients with end-stage renal disease is rare due to numerous factors that impair fertility. Even if pregnancy does occur pregnancy outcome with a live birth has a low success rate.

Case presentation

We report two cases of successful pregnancy in patients with end-stage renal disease on hemodialysis.

Conclusion

The purpose of hemodialysis is not only to maintain life but also to make quality of life as normal as possible for the end-stage renal disease patient. Propagation of life is basic to all life forms and the ability to do so can be considered as a success in a patient with end-stage renal disease.

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Most cited references 9

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Increased Plasma Leptin Concentration in End-Stage Renal Disease

E Merabet (1997)

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Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey.

T Tokumoto, Tatsuo Kobayashi, H Toma … (1999)

Since a report on the first successful pregnancy of a woman on long-term haemodialysis in Japan in 1977, there has been a growing number of case reports on successful pregnancy in patients on dialysis. We undertook a nationwide survey on pregnancy in women on renal replacement therapy in 1996. A preliminary questionaire was sent to 2504 dialysis units and 143 renal transplant units in Japan. For each reported pregnancy, a more detailed questionaire was sent to collect nephrological, obstetric and neonatal information. There were 172 pregnancies (0.44%) reported in 38889 women on dialysis, with 90 successful pregnancies (0.23%), and 194 pregnancies reported in 852 female renal transplant recipients. Detailed pregnancy information was collected from 74 women on dialysis and 194 renal transplant recipients. Of the 74 pregnancies in the women on dialysis, 36 (48.6%) resulted in surviving infants, nine (12.2%) in neonatal death, nine (12.2%) spontaneous abortions and 14 (18.9% elective abortions were reported. The outcome of six pregnancies (8.1%) was unknown. Of 194 pregnancies in renal transplant recipients, 159 (82.0%) resulted in surviving infants, two (1.4%) in neonatal death and 28 (14.4%) in spontaneous or elective abortion. In five cases the pregnancy outcome was not reported. No congenital anomalies were reported, except two infants with mental retardation and one with epilepsy. The current survey revealed that the rate of successful pregnancy in women on dialysis has improved. More than half of the pregnancies resulted in infant survival. But, premature birth is a major problem for the children of women on dialysis and there is a higher rate of neonatal death. There are significant differences in gestational age, birth weight, frequency and severity of prematurity and rates of neonatal death between pregnancies of women undergoing dialysis and those who are renal transplant recipients.

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Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry.

J H Ehrich, G Rizzoni, Rod Wing … (1991)

This study reports the geographical incidence of successful pregnancies in women on renal replacement therapy (RRT) and related information on gestation and clinical status of newborns. The impact of successful pregnancy on graft function was assessed by means of a retrospective case-control study. Since 1977 special questionnaires have been sent to each dialysis and transplant centre which reported babies born to mothers on RRT on the yearly centre questionnaire. After 10 years of data collection, a total of 490 pregnancies and 500 babies were available for analysis. A percentage of 88.4 of the babies were born to mothers with a functioning graft, 11.2% to mothers on chronic haemodialysis, and the remaining 0.4% to mothers on CAPD. Almost 50% of all successful pregnancies were reported from the UK. The number of successful pregnancies increased steadily and in parallel with the increasing number of females of childbearing age with a functioning renal transplant. The majority of mothers delivered at age 24-32. For transplanted mothers delivery occurred most commonly during the 3rd and 4th year after successful transplantation. In approximately 85% of cases the duration of pregnancy was shorter than the lower 10th percentile of normal. Birthweight was reduced in accordance with gestational age. Newborn mortality was 1.8%. Fifty-three mothers with a successful pregnancy in 1984-1987 were computer matched with controls according to a number of criteria. The serum creatinine concentration recorded in coded form at the end of each year on the individual EDTA patient questionnaire was used to assess changes in graft function.(ABSTRACT TRUNCATED AT 250 WORDS)

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Author and article information

Journal

Journal ID (nlm-ta): Cases J

Title: Cases Journal

Publisher: Cases Network Ltd

ISSN (Electronic): 1757-1626

Publication date (Electronic): 12 August 2009

Publication date Collection: 2009

Volume: 2

Electronic Location Identifier: 8139

Affiliations

[1]simpleNorthwest Louisiana Nephrology L.L.C 1800 Buckner Street, Suite C-120, Shreveport, LA 71101USA

Article

Publisher ID: 8139

DOI: 10.4076/1757-1626-2-8139

PMC ID: 2769409

PubMed ID: 19918459

SO-VID: 6dda9256-deb0-4375-ad6a-fb6c4e0202ec

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Pregnancy in end-stage renal disease patients on hemodialysis: two case reports

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Abstract

Introduction

Case presentation

Conclusion

Related collections

HLA-G and immune tolerance in pregnancy

Most cited references 9

Increased Plasma Leptin Concentration in End-Stage Renal Disease

Pregnancy in women receiving renal dialysis or transplantation in Japan: a nationwide survey.

Successful pregnancies in women on renal replacement therapy: report from the EDTA Registry.

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