Three successive pregnancies in a patient with chronic renal disease progressing from chronic renal dysfunction through to institution of dialysis during pregnancy and then on to maintenance dialysis

Frequency of conception is lower in women with chronic renal insufficiency (CRI), and even lower in those undergoing dialysis [ 1 ]. Repeated pregnancies in women on dialysis appear to be exceptional. In the literature, there are only two reports of cases of three successive pregnancies in two different patients on haemodialysis [ 2 , 3 ]. In both these cases, however, only the first pregnancy was successful. Here we present a case of a woman with IgA nephropathy who had three consecutive, successful pregnancies, the first during the pre-dialysis phase, and the other two during chronic maintenance haemodialysis. Chronic kidney disease due to IgA nephropathy was first detected at the age of 18 years. The nephropathy was not very severe—proteinuria <2 g/day, no hypertension—and did not present a rapid progression into end-stage renal disease (ESRD). The patient first became pregnant at the age of 25—serum creatinine 2.2 mg/dl, proteinuria 1 g/day and normal arterial pressure. She followed a low protein diet 0.6–0.8 g/kg body weight/day, a high calorie intake 35 kcal/kg body weight/day, and took 100 mg/day aspirin. During this pregnancy, proteinuria did not increase considerably, blood pressure (BP) remained normal ( Figure 1 ) but serum creatinine rose to 5 mg/dl ( Figure 2 ). Haemoglobin (Hb) ranged between 9.0 g/dl and 10 g/dl with oral iron and vitamin supplements. Total maternal weight gain was 13 kg. All parameters of fetal growth were normal—37 week biparietal diameter (BPD) 97 mm, head circumference (HC) 333 mm, femur length (FL) 71 mm, abdominal circumference (AC) 333 mm, humerus length (HL) 62 mm. Two weeks before delivery, intracervical dinoprostone gel was applied in four 0.5 mg successive doses. The gestation ended in the 38th week with spontaneous vaginal delivery and the live-born male baby weighed 3150 g—Apgar score 8 and 9 ( Table 2 ). He was admitted to neonatal intensive care, and was discharged after 20 days, thriving and on a normal diet.