Abstract: FR-PO0985
Intensive Hemodialysis During Pregnancy in a Patient with CKD G5 (CKD5) from Bilateral Xanthogranulomatous Pyelonephritis
Session Information
- Women's Health and Kidney Diseases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Smith, Coy, West Virginia University, Morgantown, West Virginia, United States
- Khan, Salwa, West Virginia University, Morgantown, West Virginia, United States
- Murari, Ujjwala, West Virginia University, Morgantown, West Virginia, United States
- Bergeron, Jennifer, West Virginia University, Morgantown, West Virginia, United States
- Tomar, Ojaswi Singh, West Virginia University, Morgantown, West Virginia, United States
- Kaushal, Amit, West Virginia University, Morgantown, West Virginia, United States
Introduction
Pregnancy in advanced CKD requires intensive hemodialysis (HD) to optimize maternal and fetal outcomes. Bilateral xanthogranulomatous pyelonephritis (XGP) is a rare cause of CKD5 in young adults. We describe a pregnant woman with previously undiagnosed CKD5 from bilateral XGP, managed with intensive HD.
Case Description
A 23-year-old G3P2 woman at 20 weeks gestation was referred with creatinine 4.5 mg/dL discovered on routine OB labs, with no known prior kidney disease. Imaging showed bilateral staghorn calculi with near-complete parenchymal replacement by calcifications and cystic lesions, consistent with bilateral XGP. UPCR was 5,450 mg/g with sterile pyuria; GN serologies and lupus workup were negative. Biopsy was deferred
given the absence of viable parenchyma. Left nephrostomy did not improve renal function, and a tunneled dialysis catheter was placed. Intensive HD was initiated at 4 hours, six days per week (~24 hours/week), with goal BUN below 35 mg/dL for fetal benefit. A multidisciplinary team coordinated nephrology, MFM, urology, and IR. Course was complicated by intrahepatic cholestasis (bile acids 17, treated with ursodiol), gestational diabetes, anemia requiring transfusion, and chronic suppressive antibiotics.
At 28 weeks, fetal growth was appropriate (EFW 30th percentile) and creatinine stable at 2.8-3.0 mg/dL between sessions. Cesarean delivery is planned at 38 weeks.
Discussion
She had no known kidney disease until routine obstetric labs at 20 weeks showed creatinine 4.5 mg/dL, with imaging consistent with longstanding bilateral XGP. Earlier medical care abroad had not detected it. XGP is a chronic inflammatory state, unlike the quiet kidney disease seen in most pregnancy-on-dialysis cases; the ongoing inflammation contributes to EPO resistance and may raise pre-eclampsia risk. Standard thrice-weekly HD is inadequate in CKD5 pregnancy; data favor at least 36 hours per week, but what we are aiming for is BUN below 35 mg/dL, and her ~24 hours weekly met that goal. High maternal BUN drives fetal solute diuresis and polyhydramnios, which can precipitate preterm labor, so keeping BUN low matters more than dialysis hours per week. Chronic suppressive antibiotics were essential given the bacterial load in bilateral staghorn calculi and risk of hematogenous seeding. We managed her medically rather than proceed to nephrectomy in pregnancy, deferring surgery to the postpartum period.