by email@example.com (322 Posts), Sun Jul 22, 2007 02:19 pm
There are questions for both nephrologists and obstetricians here and I will focus on the former. Also all answers are hypothetical as we do not have all the chart information here.
Abruption leads to two forms of acuter renal failure, the most common being acute tubular necrosis, but rarely acute cortical necrosis, usually of the ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œpatchyÃƒÂ¢Ã¢â€šÂ¬Ã‚Â or incomplete variety. However the latter is usually associated with very severe initial degrees of functional failure and this patient never required dialysis. Acute renal failure is usually completely reversible, normal function returning in 2-3 weeks or sooner. Rarely, and especially if the failure occurred when minimal unrecognized chronic disease was present, recovery can be slower, thus the patient may have a lower creatinine level shortly.. Thus knowing the creatinine level before the abruption even in the remote past would help the analysis here. At any rate if this creatinine value signals residual mild renal dysfunction (Here a creatinine level of 1.2 mg% is a value that could conceivably be at the upper limits of normal in a large muscular individual, but unusual in women) and the abnormal proteinuria continues, her nephrologist will most certainly do further testing, including quantifying the creatinine clearance and proteinuria, respectively, and other tests they do in the face of persistant proteinuria, possibly even suggesting renal biopsy.
For advice on future conception it is better to await assurance we are at a steady state point, and no further evaluation is necessary. However mild dysfunction, with no or controlled hypertension is still associated with good pregnancy outcomes, the repeat preecampsia is more prevalent (here >25%). All this means is future pregnancies should be watched closely, best by a high risk OB specialist, and when renal disease is present the nephrologist should also be considered for the team
The reason the Mg rose so quickly is the kidneys were not functioning, but Mg does not aggravate preeixting disease.
There is an increased incidence of repeat abruption, but that is in the OB specialistsÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ domain.