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Risks of pre-e w/ underlying kidney problems

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Risks of pre-e w/ underlying kidney problems

Postby saramhw » Tue Sep 14, 2004 04:51 pm

by saramhw (1 Posts), Tue Sep 14, 2004 04:51 pm

I am 24 weeks pregnant with my 4th child. I had regular prenatal care with my first in 1991 and birthed in the hospital. The last two I have had at home and monitored myself through pregnancy because I purposely elected to not take part in the medical management of pregnancy.

I had my first kidney infection in 1990 and was hospitalized. I had 2 during my first pregnancy (at 12 weeks & at 26 weeks or so). I had 2 more between my first and second pregnancies. I had 1 at 7 weeks pregnant with my 2nd child. One between that pregnancy and my 3rd. This was the first time that the infection did not respond to antibiotics. After 2 courses, I used the herb, uva ursi and no symptoms were present, but I didn't follow up with a culture. I had 1 more infection during my 3rd pregnancy and used the uva ursi again. I had 1 more infection last summer and again used uva ursi.

During this pregnancy, I got my first infeciton at about 14 weeks. After taking abx for 10 days, I went for 10 days before symptoms returned. After round 2 of abx, I went 33 hours before symptoms returned. I am now on prophylactic abx as recommended by the urologist and agreed to by the ob. I received a referral to a urologist who ordered a u/s of the kidneys. The u/s showed an atrophic left kidney and hypertrophic right kidney, as well as some small cysts on the left kidney. Blood tests for kidney function were ordered when I first presented and kidney function was good. I've never been infected anywhere in my urinary tract except my left kidney.

The urologist reported to the GP who diagnosed the initial infection the u/s findings and that I was not hypertensive. He suggested that I see him once the baby is born as he can't do much to help me while I'm pregnant. I have high readings when my bp is taken in the doc's office, but when I monitor it myself, my readings are always a very normal 110-114/72-76 or so. All the readings I've had done in the doctor's office have been high though. I haven't monitored my bp during this pregnancy at all. Despite doing my own prenatal care (largely consisting of weight checks, bp checks and just being in tune with my health and well being) in the past, I have sought out an ob to monitor me this pregnancy because of the kidney problems.

My first appointment didn't go as well as I'd hoped. The doctor seemed totally unconcerned with my medical history. She seemed to want to treat me as any other pregnant woman when if I felt that way, I'd not be seeing her. I am concerned about developing pre-eclampsia, but I've never had it before. I do spill protein, but generally only when I have symptoms of pylonephritis. Once I'm on abx and the infection is controlled, the protein spillage stops. I monitor my urine with a 10 test dip stick pretty much daily as I'd planned to add this when I wasn't seeking outside prenatal care. I have pitting edema in my ankles pretty much every day. I work in a sedentary job though and the edema is much less on the weekends when I don't work.

My question is can you give me more information about the risks for me of developing pre-eclampsia? In 3 other pregnancies, I've been fine, including a good blood pressure and a general feeling of well being. I have however been able to manage the infections which is something different for this pregnancy. I would really like to birth at home, but don't want to risk my or the baby's health in doing so. Do you think that I'm at any greater risk of pre-eclampsia in this pregnancy and what steps would you recommend I take to monitor my health, in conjunction with working with my ob? I'd like to be certain that the level of care is sufficient. I felt very much like just another number when seeing her. I have another appointment in 2 weeks and will reevaluate and discuss this with her as well.
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Re : Risks of pre-e w/ underlying kidney problems

Postby expert on call » Tue Oct 26, 2004 08:39 am

by expert on call (297 Posts), Tue Oct 26, 2004 08:39 am

There are very vague associations between the hypertensive complications of pregnancy (including preeclampsia), but “vague associations” by definition means that with good prenatal care such patients on the whole do well. This patient is correct to seek high-risk care that would include suppressive antibiotic therapy or frequent re-culturing of the urine and immediate treatment, perhaps electronic monitoring later in gestation. Some of the increased hypertension and other problems in these patients may signal silent underlying renal disease (that not the infection associated with increased preeclampsia). Thus Urologist is correct to want to evaluate this woman for underlying problems including reflux, malformations such as a double ureter, stone disease, etc. While most of this can only be done postpartum, other simple tests such as a measurement of renal function (creatinine clearance), and a single film (rather than expensive magnet resonance)imaging to rule out radio opaque stones can be done during pregnancy.

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