Because of its generally late onset, adult polycystic kidney disease is uncommon in pregnancy (Banks, 2015). The prognosis for pregnancy in these women depends on the degree of associated hypertension and renal insuiciency. Urinary tract infections are common. One study compared pregnancy outcomes in 235 afected women who had 605 pregnancies with those of 108 unafected family members who had 244 pregnancies (Chapman, 1994). Composite perinatal complication rates were similar-33 versus 26 percent. However, hypertension, including preeclampsia, was significantly more frequent in women with polycystic kidneys. Pregnancy does not seem to accelerate the natural disease course (Lindheimer, 2007b).
he glomerulus and its capillaries are subject to various conditions and stimuli that can lead to acute and chronic diseases. Glomerular damage can be caused by toxins or infections or from systemic diseases that include hypertension, diabetes, or systemic
TABLE 53-3. Patterns of Clinical Glomerulonephritis lupus erythematosus (Lewis, 2015). It may also be idiopathic. When there is capillary inflammation, the process is termed glomerulonephritis, and oten, an autoimmune process is involved.
Persistent glomerulonephritis eventually leads to worsening renal function. Progression is variable and often does not manifest until chronic renal insuiciency is diagnosed. Lewis and Neilson (2015) group glomerular injuries into six syndromes based on clinical patterns (Table 53-3). Within each of these categories, there are disorders encountered in young women, and thus, these may antedate or irst appear during pregnancy.
Acute glomerulonephritis may result from any of several causes (see Table 53-3). The clinical presentation usually includes hypertension, hematuria, red-cell casts, pyuria, and proteinuria. Varying degrees of renal insuiciency and salt and water retention result in edema, hypertension, and circulatory congestion (Lewis, 2015). The prognosis and treatment of nephritic syndromes depends on their etiology. Some recede spontaneously or with treatment. However, in some patients, rapidy progressive glomerulonephritis leads to end-stage renal failure, whereas in others, chronic glomerulonephritis develops with slowly progressive renal disease.
Lupus nephritis identified before pregnancy has a 50percent chance of laring during pregnancy (Koh, 2015). IgA nephropathy, also known as Berger disease, is the most common form of acute glomerulonephritis worldwide (Wyatt, 2013). he isolated form occurs sporadically, and it may be related to Henoch-Schonlein purpura as the systemic form (Donadio, 2002). Isolated nephritis may be due to anti-glomerular basement membrane (anti-GBM) antibodies. hese may also involve the lungs to manifest as a pulmonary-renal syndrome with alveolar hemorrhage, which is termed Goodpasture syndrome (Friend, 2015; Huser, 2015).
Acute nephritic syndromes during pregnancy can be diicult to diferentiate from severe preeclampsia or eclampsia (Cabiddu,
Acute Nephritic Syndromes: poststreptococcal, infective endocarditis, SLE, antiglomerular basement membrane disease, IgA nephropathy (Berger disease), ANCA
Henoch-Schonlein purpura, cryoglobulinemia, membranoproliferative and mesangioproliferative glomerulonephritis