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World Journal of Pharmaceutical
and Medical Research

An International Peer Reviewed Journal for Pharmaceutical and Medical Research and Technology
An Official Publication of Society for Advance Healthcare Research (Reg. No. : 01/01/01/31674/16)
ISSN 2455-3301
IMPACT FACTOR: 4.639

ICV : 78.6

Abstract

PREGNANCY FOLLOWING KIDNEY TRANSPLANT: CASE REPORT AND LITERATURE REVIEW

Tibeică Alexandra-Maria MD, Ursache Alexandra MD, Tănase Adina-Elena MD, Berescu Anca MD, Petică Mirabela MD and Onofriescu Mircea MD PhD*

ABSTRACT

Pregnancies in women with chronic kidney failure are considered as high-risk pregnancies because there are some possible complications that may occur during pregnancy and may affect the mother, the foetus, or both of them. We present the result of a successful case both for the mother and for the baby, as well as the effects of pregnancy on the function of the transplanted kidney and hemodynamics. We describe the effects of pregnancy on renal function and the effects of renal disease on the foetus. The 36-year-old patient, with a background of recurrent urinary infections and hypertension, was initially introduced to the nephrology department for investigating bilateral renal dysplasia for which peritoneal dialysis was initiated. The patient underwent dialysis for 4 years and then received renal transplantation from a donor. Prior to transplantation, she received antihypertensive treatment for 5 years and eventually developed end-stage renal disease. After the transplantation, the renal functional tests were normal and the patient did not experience any hypertension. The patient was registered at 12 weeks with amenorrhea, with BP (blood pressure) within normal range, normal kidney function, absence of proteinuria. Throughout the pregnancy, the patient consistently received immunotherapy with cyclosporine 75 mg X 2 / day, and the serum concentration of cyclosporine was periodically monitored to track the need for dose adjustment, with a level of A_C2 = 302.7ng/ml at 15 weeks and 286ng/ml at 35 weeks, Imuran 50mgx2/day, Prednisone 5mg/day, Mecopar 2 caps/day, Silymarin 3 caps/day, vit. D3 1 cap/ day, Elevit 1 cap x 2 / day, Folic Acid 5mg x 2/day. At 32 weeks, it was initiated a treatment for foetal lung maturity with Dexamethasone ¾ ampoule every 12 hours, for 48 hours. At 35 weeks, there was evidence of chronic immunosuppression, mixed dyslipidaemia, asymptomatic hyperuricemia, normocytic normochromic anaemia. TOTHEMA 1cap x 2 / day is added to the daily treatment. The CTG exam reveals an average heart rate of 140 BPM with good variability, the presence of accelerations and the absence of significant decelerations. At 37 weeks, due to the increase in BP values - despite the treatment with Nifedipine - and the increase of proteinuria and uric acid, C section was performed, resulting in a single living newborn male, W = 2900g, APGAR = 9. Bilateral tubal ligation was performed at the request of the patient. Post-procedure treatment was given, Dostinex 1/2 cap every 12 hours for ablactating, Dopegyt 1cap/6h for BP control, Innohep 1 ampoule /day for anticoagulation, Cefotax 2gx12 hours. The patient is discharged in good general health state, afebrile, physiologically underdeveloped uterus, lochia in normal quantity and appearance, BP and P within normal physiological parameters.

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