[Prenatal care in patients with renal disease].

HISTORY AND CLINICAL FINDINGS: We report of three pregnancies, two with renal insufficiency and one with a history of renal transplantation. Pat.1 is a 32y at 20 weeks of gestation with acute renal failure, nephrotic syndrome and history of familial Mediterranean fever. Case 2 is a 23y with cirrhotic kidneys, stage 5 of chronic kidney disease and dialysis treatment 3 × a week. The pregnancy was an incidental finding. Pat. 3 is a 29y I/0 with history of renal transplantation years ago.

DIAGNOSIS, TREATMENT AND COURSE: In pat. 1a renal biopsy confirmed the suspected diagnosis of AA amyloidosis. Due to deterioration of the kidney function, she required dialysis up to 6 × a week. In Case 2 the dialysis increased to 6 × a week as well. In both patients, we indicated delivery at 35 weeks of gestational age. Pat. 3 delivered at term without complications.

CONCLUSION

A close interdisciplinary cooperation improves neonatal outcome in pregnant women with CKD. Counseling and risk assessment of these patients should be initiated before pregnancy. The care of these high-risk pregnancies needs to be performed at a tertiary care center with the above-mentioned specialists.