[Anuria in the third trimester of pregnancy in a patient with renal transplant]

We present a pregnant patient with a transplanted kidney experiencing chronic rejection, with chronic kidney failure and arterial hypertension. During the third trimester the patient's kidney function deteriorated somewhat and hypertension worsened. In the thirty-second week of pregnancy uterine activity increased, fetal movement decreased and oliguria progressed rapidly to anuria, leading to an emergency cesarean section. Surgery was performed under epidural anesthesia; after removal of the fetus diuresis immediately began and was maintained. Both mother and infant recovered, but after three months the patient entered a hemodialysis program due to terminal kidney failure. The risk of acute kidney failure is greater in the parturient who has been the recipient of a transplanted kidney because of the functional overload that pregnancy involves, the possible exacerbation of acute or chronic rejection, and the higher incidence of pyelonephritis and preeclampsia. The extraperitoneal location of the transplanted organ in the iliac fossa may cause obstructive anuria. Our patient's recovery of diuresis immediately after removal of the fetus suggests that the excretory channel coming from the kidney was compressed by the uterus.