[Chronic renal disease and gravidity--case study]

Uremia, the result of renal failure, is a serious clinical problem. Rising azotemia during gravidity significantly increases perinatal morbidity and mortality. This study presents the case of 34 years old patient with 27-year medical history of diabetes mellitus type 1 with diabetic nephropathy and chronic renal insufficiency. The patient got pregnant in the stage of preterminal renal failure. During the first trimester, she showed hypertension and proteinuria. In her 25th week of pregnancy, she was hospitalized with progressive proteinuria, almost uncontrollable hypertension and increased azotemia. Intensive conservative therapy led to a slight decrease of azotemia and proteinuria levels which, however, remained high. In fact, we considered using elimination methods several times. Due to severe hypoxia of the foetus, the gravidity was terminated by section at 30 weeks. After the parturition, the newborn had to be resuscitated. In the first days, the newborn showed increased azotemia which decreased spontaneously after several days. In a month after the termination of gravidity, N-substances increased again and the patient was enrolled in the chronic dialysis programme.