Abstract: PO1197
Life Finds a Way: Two Successful Pregnancies in a Woman Without Kidneys
Session Information
- Hemodialysis and Frequent Dialysis - 4
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Curtis, Anna Katherine, University of Missouri Kansas City, Kansas City, Missouri, United States
- Lamb, Christian C., US Army Brooke Army Medical Center Medical Library, Fort Sam Houston, Texas, United States
- Atallah, Sarah, University of Missouri Kansas City, Kansas City, Missouri, United States
- Patel, Amit Jashbhai, University of Missouri Kansas City, Kansas City, Missouri, United States
Introduction
Bilateral nephrectomy is a controversial and rarely used approach to control refractory hypertension in patients with anuric end-stage renal disease (ESRD) who require dialysis. This extreme measure results in complete dependence on dialysis to maintain metabolic homeostasis. This procedure has become rare due to advances in anti-hypertensive pharmacotherapy. Given the rarity of this approach, there is a paucity of literature regarding how the absence of kidneys after bilateral nephrectomy impacts childbearing. We present the first known case of successful pregnancy in a woman on intermittent hemodialysis (iHD) without kidneys due to bilateral nephrectomy.
Case Description
The patient was a 31-year-old female who had ESRD secondary to hypertension and atypical hemolytic uremic syndrome (aHUS). She was diagnosed with aHUS condition during her first pregnancy and was initiated on biweekly infusions of eculizumab after delivery. Seven months after delivery, she underwent bilateral nephrectomy to control her hypertension. Two years following nephrectomy, she presented to the Emergency Department (ED) with dyspnea. Her urine β-HCG was positive and ultrasonography confirmed an intrauterine pregnancy. Throughout this pregnancy, she required iHD six days weekly. She delivered at 27 weeks gestation and after a short stay in the neonatal intensive care unit (NICU) her baby was discharged home in healthy condition. Two years later, the patient presented to the ED and was again found to be pregnant. She was managed with HD six days weekly. This child was born at 23 weeks gestation and was discharged home after several weeks in the NICU.
Discussion
Theoretically, bilateral nephrectomy can curtail regulatory mechanisms leading to hypertension. This approach has fallen out of favor given advancements in pharmacotherapy. There is almost no known scientific literature regarding how the absence of kidneys after bilateral nephrectomy impacts childbearing. On an extensive review of the literature regarding bilateral nephrectomy and pregnancy, only one case report was identified. This article details a Saudi Arabian woman receiving intermittent peritoneal dialysis who successfully carried a pregnancy to 29 weeks, with the birth of a healthy child. This report highlights the lack of literature regarding managing pregnant patients on iHD, especially those without kidneys.