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Kidney Week

Abstract: PO2606

Successful Pregnancy in a Patient with Congenital Renal Dysplasia After Initiation of Dialysis

Session Information

Category: Trainee Case Report

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Tang, Jennifer Chiwing, University of Southern California Keck School of Medicine, Los Angeles, California, United States
  • Khine, Annika K., University of Southern California Keck School of Medicine, Los Angeles, California, United States
Introduction

Chronic kidney disease (CKD) is a well-known risk factor for adverse maternal and fetal outcomes including preeclampsia and fetal growth restriction. For those on dialysis, increasing the frequency and duration of dialysis has shown to optimize outcomes. However, it remains unclear if and when pregnant patients with CKD should start dialysis to improve outcomes. We present a patient with congenital renal dysplasia who successfully gave birth after starting dialysis.

Case Description

A forty-one-year-old female with an intrauterine pregnancy of 25 weeks and a history of two miscarriages, preeclampsia, and congenital renal dysplasia presented to nephrology clinic. Patient was unaware of her kidney dysfunction and had residual renal function with a creatinine of 3.76 and urine pr/cr ratio of 1.18. A fetal ultrasound revealed a fetal weight in the 12th percentile, head circumference in the 2nd percentile, and biparietal diameter (BPD) in the 33rd percentile. Therefore, the patient started daily dialysis with longer sessions to optimize fetal outcomes. A repeat ultrasound two weeks later revealed interval growth with a fetal weight in the 24th percentile and BPD in the 45th percentile but with abnormal umbilical artery Doppler findings, an indicator of small gestational age. The patient was admitted at 31 weeks due to concern for preeclampsia and continued daily dialysis. Due to labile blood pressures and fetal decelerations, the patient underwent a C-section at 32 weeks and delivered a newborn with an APGARS score of 6/8. Both the patient and her baby were eventually discharged home without complications.

Discussion

Initiation of dialysis resulted in significant interval fetal growth and this patient’s first viable infant. Further research is warranted to assess if starting dialysis earlier in pregnant patients with CKD may improve fetal outcomes.

Fetal ultrasound prior to dialysis with a femur length in the 6th percentile and an estimated fetal weight of 635 grams in the 12th percentile.