single kidney

[ehuff]

I had a nephrectomy during my first pregnancy at 21 wks (as a result of kidney cancer) and no further complications - textbook pregnancy afterwards. Delivered at 40 wks with C-section due to breech. Now, in my second pregnancy, I am at 31 weeks and have suddenly had high BP (140/90) and protein in my urine (maybe predicted by my high hCG levels at quad screen test??). While on rest, protein was 5g/day and BP dropped to 128/78. OB thinks this is due to single kidney and might be "normal" for me, but I am suspicious as I had no problems the first time around. No sign of IUGR at this point. I am concerned about stressing my single kidney to point of permanent damage - are these values of concern?

Erika
Brendan 40w 3/21/00

[expert on call]

The problems you are having may indeed be due to your single kidney. When you have a kidney removed, the total amount of work done by your kidneys to clean your blood does not go down very much. The remaining kidney takes up the slack by perfusing the remaining glomeruli more. Pregnancy itself results in increased perfusion of the kidney. Over working a kidney can result in proteinuria. Most women have very successful pregnancies with a single kidney. Some develop complications.

You are at 31 weeks and do not seem very close to needing delivery due to your BP. Babies born at 32 weeks or greater do very well. Even if your condition progresses over time, you should expect a good outcome but possibly with a complicated course.

5 grams of proteinuria is NOT normal. Neither are BP's of 140/90. Given dBP's > 90 and proteinuria, you already have preeclampsia. I would expect the disease process to progress. We just do not know how fast it will progress. You could become sick next week; it could be several weeks.

To the extent that your proteinuria is due to the pregnancy, it should resolve. It may not resolve entirely; you may have some underlying renal condition. Postpartum, you might best see a nephrologist to evaluate your condition. Blood pressure drugs such as ACE-inhibitors can help reduce your proteinuria and preserve your kidney function if problems remain. (We generally do not use these in pregnancy). Current recommendations suggest that your non-pregnant BP's should be < 70.

Weekly visits with fetal monitoring would be appropriate. While you do not seem to be seriously ill right now, (and you may not become sick), you have a significant chance of rapidly evolving to severe preeclampsia.

Given your complex pregnancy condition, it would be perfectly appropriate to consult with a maternal fetal specialist. Listings of specialists are available at http://www.smfm.org/ and specialists that focus on hypertensive pregnancies are available at http://www.nasshp.com

Best wishes

Expert on Call

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