It is a clinical form of late toxicosis. This is a complex of symptoms that can accompany a woman in the second half of pregnancy. A similar disorder appears in young women during the first pregnancy, as well as after 35 years. Multiple pregnancy increases the risk of developing nephropathy. Overall, it occurs in 15 percent of pregnant women. In addition, nephropathy is found in almost half of expectant mothers suffering from extragenital diseases.

Nephropathy of pregnancy is characterized by:

• hypertension (sustained increase blood pressure);
• swelling;
• proteinuria (increased protein content in the urine).

Although this disorder is localized in the kidneys, great harm it does not affect these organs. As a rule, after childbirth, a woman forgets about nephropathy. But if the patient does not receive proper treatment, nephropathy can become severe:

• preeclampsia, which threatens the functioning of the placenta;
• eclampsia, which entails hemodynamic disturbances and threatens the life of the mother and the fetus.

With the progression of complications of nephropathy, there is a multiple increase in the protein content in the urine, and the volume of fluid excreted from the body reaches a level of half a liter and below. This indicates the development of renal failure in a pregnant woman, in which the kidneys cease to perform their basic functions. Obviously, a disease such as nephropathy of pregnancy can have the most dire consequences, so its appearance cannot be ignored.

Causes of nephropathy in pregnant women

Science still cannot give an exact answer to the question of why nephropathy develops in pregnant women. Today, there are several dozen theories on this score. Some of them have already lost their relevance or have been refuted:

• fetal theory of the genesis of nephropathy: the mother's body is poisoned by the metabolic products of the fetus;
• allergic theory of the genesis of nephropathy: protein substances with allergenic properties are formed in the placenta or in the body of the fetus, which adversely affect the mother's body.

For a long time it was believed that the main reason for the appearance of late toxicosis in pregnant women is hemodynamic disorders in the kidneys. Initially, scientists were of the opinion that pregnancy provokes kidney disease. Later, they began to take into account the pressure of the uterus on these organs, causing ischemia. However, observations have shown that nephropathy can be detected in the absence of kidney exposure.

The following theories have become widespread today.

1. The theory of neurogenic genesis of nephropathy. It implies that this pathology develops under the influence of a violation of the adaptive mechanisms of the higher parts of the nervous system to the restructuring of the body during pregnancy. This fully explains vascular disorders characterizing nephropathy.
2. The theory of hormonal genesis of nephropathy. She claims that metabolic products accumulate in the ischemic uterus, which activate the increased production of adrenal hormones. This, in turn, causes the kidneys of the pregnant woman to actively produce the hormone renin, which is also produced outside of them.
3. The theory of the immune genesis of nephropathy. It says that the fetus is perceived by the mother's body as a foreign object, since it has half of the father's antigens. At the same time, the placenta is considered as an immune barrier that slows down the entry of antigens into the pregnant body. If the placental barrier is violated, immune tolerance decreases: antibodies are produced, and a conflict occurs. As a result, fibrinoid deposits appear in the capillaries of the kidneys, which impede normal hemostasis.

It is also worth noting that late toxicosis of pregnant women is provoked by some diseases:

• diabetes;
• hypertension;
• heart disease;
• obesity;
• residual effects of pyelonephritis.

If nephropathy of pregnant women is accompanied by these diseases, it is called secondary. Primary nephropathy resolves with an uncomplicated history.

Symptoms of nephropathy

When it comes to a disease such as nephropathy of pregnancy, symptoms should be classified depending on what degree of pathology is observed.

The first degree of nephropathy of pregnancy:

• the volume of edema is small, the location is mainly on the legs;
• hypertension - mild (blood pressure below 170/90 mm Hg. Art.);
• proteinuria - functional (up to 1 gram per liter).

The second degree of nephropathy of pregnancy:

• the volume of edema is moderate, the location is on the arms, legs and the anterior abdominal wall;
• hypertension - moderate (blood pressure below 150/100 mm Hg. Art.);
• proteinuria - moderate (up to 3 grams per liter).

The third degree of nephropathy of pregnancy:

• the volume of edema is large, the location is throughout the body;
• hypertension - severe (blood pressure below 180/100 mm Hg. Art.);
• proteinuria - massive (more than 3 grams per liter).
• cylindruria - the appearance in the urine of casts of protein;
• oliguria - a decrease in the volume of urine excreted.

In addition, a pregnant woman with nephropathy complains of general weakness, bowel disorders, back pain, worsening sleep, and decreased vision.

If liver damage occurs in parallel, it can manifest itself as jaundice and pain in the right hypochondrium. If nephropathy of pregnant women gave a complication to the heart, then ischemic myocardiopathy may develop.

Diagnostics of the nephropathy of pregnant women

Speaking about diagnostics, first of all, it is worth determining which doctor should deal with it. Let us recall the main thing that we already know about such a disease as nephropathy of pregnant women: what it is, how it manifests itself. It can be concluded that the primary diagnosis can be made by both the therapist and the gynecologist who is observing the patient's pregnancy.

Edema can be a reason to draw the doctor's attention to the possible appearance of nephropathy. A pregnant woman is able to detect them on her own. They are indicated by the inability to remove the ring from the finger or the feeling that the shoes have become small. In addition, pressing on the inner surface of the lower leg, leaving a mark, also indicates the presence of edema.

In order not to miss the onset of late toxicosis in a pregnant woman, you need to carefully monitor the following indicators:

• body weight (dynamics of weight gain);
• indicators of urine analysis;
• the volume of fluid excreted from the body through the genitourinary system.

These parameters can be controlled by the therapist. The gynecologist who is treating a patient with suspected nephropathy is required to carry out the following diagnostic measures:

• obstetric ultrasound;
• Doppler ultrasonography of uteroplacental blood flow;
• cardiotocography, which allows you to monitor uterine contractions and fetal heartbeat.

These manipulations make it possible to clarify the condition of the child and the quality of the placenta.

If nephropathy is detected in pregnant women, a woman may also be sent for consultation to an ophthalmologist. This disease in most cases causes hypertensive angiopathy, in which the veins of the fundus expand, and the arteries, on the contrary, narrow. If this manifestation is left unattended, there is a risk of minor hemorrhages, retinal edema and even retinal detachment.

The pregnant woman may need a more thorough examination by a nephrologist. Diagnostics will allow you to establish whether a woman has abnormalities of the urinary system. The study of the adrenal glands will not hurt either.

Treatment of nephropathy of pregnancy

As noted, nephropathy requires immediate treatment. Its progression entails such dangerous consequences as:

• spontaneous termination of pregnancy;
• placental abruption (even if its location is assessed as normal);
• hypoxia (oxygen starvation) of the child, which can lead to his death;
• uterine bleeding in the mother (both immediately after childbirth and in the early postpartum period).

A disease such as nephropathy of pregnant women, treatment involves exclusively inpatient treatment. At the first and second degrees of nephropathy, the woman is referred to the department of pathology of pregnant women, at the third it is recommended to contact the intensive care unit. Only in a hospital can you closely monitor the work of the kidneys, the dynamics of blood pressure, the content of electrolytes. If the disease is detected at the initial stage, then hospitalization will last no more than ten days.

The main method of dealing with nephropathy is medication. The therapy has the following goals:

• reimbursement of protein losses;
• normalization of hemodynamics at the macro and micro levels;
• removal of angiospasms.

One of the most effective drugs in this case is magnesium sulfate. It is administered intramuscularly in dosages selected in accordance with the degree of nephropathy.

In addition, in the hospital, a pregnant patient should be provided with medical and protective measures, including:

• a specially formulated diet;
• support for an optimal rest regimen;
• providing bed rest for at least three days;
• the appointment of sedatives, including to combat insomnia;
• regulation of bowel function.

Discharge from the hospital is possible only with the complete elimination of all signs of nephropathy in a pregnant woman. Upon returning home, a woman should follow these recommendations:

• follow the diet developed by the attending physician;
• visit more often fresh air to improve blood supply to the placenta;
• drink more water;
• avoid stress.

It is also worth noting that after the treatment of nephropathy of pregnant women, in most cases, natural childbirth is possible. Caesarean section can be prescribed if therapy has not brought the desired result (for example, high blood pressure is maintained), there is a threat of placental detachment or hypoxia.

Prognosis for nephropathy of pregnant women

A timely diagnosis, adequate therapy and strict compliance by the patient with all the doctor's recommendations allow us to give a rather favorable prognosis. If nephropathy can be cured, the pregnancy continues and ends successfully.

However, the obstetrician should be aware that the woman in labor has suffered nephropathy during pregnancy. In such cases, measures should be taken such as:

• special approach to anesthesia;
• prevention of child hypoxia;
• careful monitoring of the condition of the expectant mother.

As for negative predictions, they are given when nephropathy manifested itself in an unusually early dates or for a long time did not respond to treatment. The transition of nephropathy of pregnant women to preeclampsia or eclampsia, which threaten the life of the mother and the child due to damage to the central nervous system and lungs, is extremely dangerous.

Prevention of nephropathy in pregnant women

Minimum preventive measures- This is a careful monitoring of the most important indicators of the condition of a pregnant woman. Medicine has not yet come to a firm conclusion on how to prevent the development of this pathology. Risk factors can be established taking into account the pathogenetic significance of endothelial-platelet abnormalities in a pregnant woman.

If they are found, the patient can be prescribed small doses of acetylsalicylic acid. In this way, the production of thromboxane in platelets is inhibited, but this will not affect the synthesis of prostacyclin by the vascular endothelium. Basically, this measure acts on pregnant women with antiphospholipid syndrome.

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Nephropathy of pregnancy is one of the most serious complications of gestosis that occurs on later dates gestation. The development of nephropathy in pregnant women can cause premature birth and other serious complications.

The exact causes of nephropathy and gestosis are still not known. It is assumed that impairment of the mechanisms of adaptation to pregnancy plays a role in the development of this pathology. Failure occurs at the earliest stages of the formation of the embryo, at the time of implantation of the ovum into the wall of the uterus. The mechanisms of this process remain practically unexplored at the moment.

As a result of all the processes occurring, the normal development of the uterine arteries is disrupted. During pregnancy, such vessels cannot cope with their immediate task - to provide oxygen and nutrients to the baby. Arterial spasm occurs, fetal hypoxia develops. A number of pathological processes are launched that interfere with the normal course of pregnancy.

The severe course of gestosis is almost always accompanied by impaired renal function and the development of nephropathy. With this pathology, small-point hemorrhages occur in the parenchyma, capsule and pelvic-cup system. Emerging changes interfere with normal work kidney, which leads to the development of the main symptoms of the disease.

Risk factors for developing nephropathy:

• metabolic disorders (obesity, diabetes and others);
• kidney pathology;
• hypertonic disease;
• heart disease;
• anemia.

Signs of nephropathy

There are several stages of the disease:

1. Preclinical stage... The development of nephropathy is preceded by the preclinical stage of the disease. This condition occurs as early as 14-16 weeks of pregnancy and is characterized by minimal changes in blood and urine tests. No other symptoms were observed in the preclinical stage. A pregnant woman feels well and does not even know about the changes that have begun in her body.
2. Edema... Nephropathy usually develops after 20 weeks of pregnancy. The disease begins with the appearance of edema - the very early symptom gestosis. Swelling during pregnancy is mainly associated with fluid retention and impaired water-salt metabolism. The cause of edema is also considered to be an increase in the permeability of the vascular wall and hormonal changes in the body. future mother.

In the initial stages of the disease, it is quite difficult to recognize edema. Two signs will help detect fluid accumulation:

• weight gain of more than 300 g per week;
• “Ring symptom” (a pregnant woman takes off all rings, as jewelry becomes too small for her).

In the future, visible swelling appears on the ankles and legs. In severe cases, the swelling spreads to the thighs, abdomen, and the entire surface of the body. Some women have face swelling. Swelling is most pronounced in the evening. During the night, the liquid is evenly distributed throughout the body, and by the morning the puffiness subsides somewhat.

At the moment, not all edema is considered a manifestation of preeclampsia. Many experts consider swelling to be normal during pregnancy and does not require any special treatment. Edema, not accompanied by an increase in blood pressure and changes in the kidneys, does not pose a danger to the expectant mother.

Complications of nephropathy

Inadequate treatment of nephropathy and hypertension of pregnancy can lead to the development of preeclampsia. This condition is characterized by the following symptoms:

• headache;
• nausea and vomiting;
• visual disturbances (flashing of flies before the eyes, the appearance of a veil);
• insomnia or severe drowsiness;
• memory impairment.

Preeclampsia can quickly turn into eclampsia with the development of generalized seizures. Loss of consciousness occurs during an attack. After the seizures resolve, the woman may regain consciousness or fall into a coma. Eclampsia most often develops during childbirth or in the postpartum period against the background of high blood pressure and renal dysfunction.

Not only eclampsia threatens a pregnant woman. Against the background of a pronounced spasm of the uterine arteries, chronic placental insufficiency... As a result, the baby does not receive oxygen in the amount he needs. There is fetal hypoxia, leading to its delay intrauterine development... This condition can result in various health problems for the newborn, including a noticeable delay in mental and physical development.

Pregnancy nephropathy is one of the causes of premature birth. Often, obstetricians have to perform an emergency caesarean section at any stage of pregnancy in order to save a woman's life. Placental abruption and bleeding may also be a reason for surgery.

Diagnostics

• every 14 days - up to 30 weeks;
• every 7-10 days - after 30 weeks.

This approach allows you to timely detect any abnormalities in the work of the kidneys, including nephropathy. The development of the disease is evidenced by the appearance of protein in the urine. The combination of this symptom with arterial hypertension and edema is an unfavorable sign and indicates a high risk of serious complications.

Proteinuria (protein in the urine) is a late sign of nephropathy. To detect the disease in the early stages, all pregnant women need to monitor their weight and blood pressure. To assess the condition of the fetus, ultrasound and Doppler blood flow in the uterine, placental and fetal vessels are performed.

Treatment principles

Treatment of nephropathy of pregnant women is carried out in a hospital. With this pathology, the risk of sudden development of complications is very high, therefore, a pregnant woman should be under round-the-clock supervision of a doctor. In the course of therapy, blood pressure, body weight and daily urine output must be monitored.

1. Antihypertensive therapy (drugs that stabilize blood pressure).
2. Infusion therapy (drugs to improve hemodynamics and blood coagulation properties.
3. Angicoagulants (drugs that prevent blood clots).
4. Normalization of uteroplacental blood flow.
5. Treatment of accompanying complications of pregnancy.

The question of the due date is decided individually. Indications for early delivery may include the following situations:

• severe course of nephropathy;
• lack of effect from treatment;
• delayed fetal development of the III degree;
• eclampsia;
• bleeding and other complications.

Natural childbirth is possible if the condition of the woman and the fetus is satisfactory (according to laboratory examinations and ultrasound). With the development of complications, a cesarean section is performed.

Prophylaxis

Specific drug prevention of nephropathy and severe preeclampsia has not been developed. Pregnant women are advised to closely monitor their condition, monitor weekly weight gain and blood pressure numbers. Timely treatment of diseases of the kidneys, heart and blood vessels also reduces the risk of developing nephropathy and all dangerous complications of this condition.

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Pregnancy is a complex physiological process, often accompanied by such a phenomenon as toxicosis. There is early and late toxicosis (nephropathy of pregnant women, dropsy - preeclampsia). The latter is less common and not as widely known as the early one, but quite often found in the third trimester of pregnancy, its manifestation is somewhat more complicated and is not limited to nausea, vomiting, and dizziness. From a medical point of view, in books on gynecology and obstetrics, both types of toxicosis are regarded as pathology.

Late toxicosis manifests itself in the form of diseases such as:

• dropsy - excessive accumulation of fluid in the subcutaneous fat, tissues;
• nephropathy of pregnancy - toxic kidney damage during pregnancy;
• preeclampsia and eclampsia.

The disease can manifest itself as early as the 20th week of pregnancy, although in most cases it is recorded after 34 weeks (about 90%). At the same time, a pattern can be traced: the later in time and closer to childbirth, nephropathy of pregnant women began, the more optimistic the forecasts, and vice versa. With a mild form of late toxicosis in the first pregnancy, the likelihood of its manifestation in subsequent pregnancies becomes lower.

Nephropathy and its classification

Late toxicosis begins with the appearance of edema (dropsy), can turn into nephropathy of pregnant women, as well as preeclampsia (high blood pressure and the presence of protein in the urine) and eclampsia - the last and most severe phase of preeclampsia with seizures. Moreover, this transition can be either gradual or rapid. The cause of the formation of nephropathy in pregnant women has not been established for certain. There is an assumption that the problem is still associated with impaired blood circulation, namely, its decrease in internal organs, including the uterus, placenta, kidneys. The RAS (the hormonal system that regulates blood pressure) reacts to all these changes, and the level of antidiuretic hormone produced by the body increases. It happens:

• primary, manifested by an increase in blood pressure, edema, proteinuria (protein in the urine), occurs in women with healthy kidneys;
• and secondary, manifests itself against the background of previously existing diseases: glomerular nephritis and other renal diseases, including hypertension, heart defects, aortic insufficiency with an increase in blood pressure, while the risk of adverse consequences for the mother and child increases.

The incidence of this disease varies from 2.2 to 15.0%. To this day, nephropathy of pregnant women remains one of the leading "culprits" of maternal mortality in the world (its share is 20-33%). About 50,000 women die each year. The main causes of death are:

• CNS damage (hemorrhagic and ischemic stroke, cerebral edema);
• pulmonary edema;
• liver necrosis;
• acute DIC syndrome.

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Symptoms of nephropathy

Nephropathy in pregnancy usually presents with three symptoms: hypertension, swelling, and the presence of protein in the urine. This combination is diagnosed in 50-60% of patients. A doctor can already diagnose nephropathy when at least two symptoms are found, but a single manifestation also occurs.

Hydrocephalic syndrome

The most common manifestation of nephropathy is hydrocephalic syndrome. Taking into account that under normal conditions of pregnancy, blood pressure practically does not change, it can be considered unlikely that hypertension will turn into a malignant form. The situation is much more dangerous if a woman already had health problems associated with hypertension before pregnancy. If so, then late toxicosis is more difficult.

Edematous syndrome

Edema syndrome ranks second in frequency of diagnosis in pregnant women. This phenomenon is associated with the retention of water and chloride in the body. Swelling can occur on different parts of the body and if the legs just swell, then this is not so critical, but when such phenomena as swelling of the face, hands, legs, thighs appear, it is worth consulting a doctor to prevent circulatory disorders in a pregnant woman and, as a result, restoring normal oxygen access to the fetus. The presence of edema can be easily checked by pressing a finger in the intended place, and if there is a dent, then it can be argued that there is one.

Kidney damage

Nephropathy in pregnant women primarily disrupts the work of the kidneys and if at the initial stages (in a mild form of manifestation) the excretion of protein in the urine does not affect health and disappears without a trace soon after childbirth, then with a complex form of flow negative impact on them, the daily excretion of urine decreases, while the level of protein in it increases. There is a chance of developing kidney failure. There are also symptoms of fundus transformations (retinal edema, minor hemorrhages and foci of degeneration). With stabilization of blood pressure, stabilization of the fundus is also noted, otherwise a decision may be made on urgent delivery.

Pathogenesis of the disease

Exists a large number of hypotheses about what is the reason for the appearance of nephropathy in pregnant women, among the total number, the following can be distinguished:

• Dysfunctions of the central nervous system (set on the EGS before the manifestation of symptoms), pathology is formed due to a violation of the mechanisms of the higher parts of the NS to the reorganization of processes in the body of a pregnant woman. This sufficiently explains the disorders of the vascular system that characterize nephropathy.
• Disruption of hormonal balance, metabolic products accumulate in the uterus, which provokes an increase in the production of adrenal hormones, which further forces the kidneys to actively produce the hormone renin, which is produced outside of them.
• An immunological conflict between a mother and a child with the appearance of circulating immune complexes, while the fetus is accepted by the mother's body as a foreign object, since it owns half of the father's antigens.
• Previous and existing diseases: diabetes, overweight, hypertension, heart disease, nephritis and glomerulonephritis.

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Diagnosis of nephropathy during pregnancy

When diagnosing this disease, the gynecologist primarily relies on the above three main symptoms, namely: hypertension, swelling and the presence of protein in the urine. Of fundamental importance is the competent management of pregnancy: timely measurement of blood pressure, control of weight gain, passing urine analysis, determining the daily volume of urine. If necessary, the pregnant woman is sent for additional consultations and studies (ultrasound, ECG, biochemical blood tests) to other specialists (ophthalmologist, cardiologist). All these measures will allow you to recognize the disease in advance and take the necessary measures.

Complications

With early diagnosis and treatment of nephropathy in pregnant women, the outcome is generally favorable. Normalization of the condition occurs either after 3-7 days after childbirth, or within a month and a half. Puffiness disappears, hypertension disappears, kidney function is restored (previously harmful changes are not found in the renal tissue).

When a diagnosis of preeclampsia is made, there are signs of pernicious hypertension (headaches, nausea, vomiting) up to mental disorders, the temperature rises, and respiratory arrest is possible. Initially, an attack of eclampsia manifests itself in a slight shuddering of the muscles of the face, eyelids, then there are tonic convulsions, up to clonic. But the most undesirable consequences of a severe form of nephropathy in pregnant women include uterine bleeding in the mother, placental abruption, fetal hypoxia, miscarriage.

Nephropathy treatment

• strict monitoring of blood pressure, kidney function, checking the content of electrolytes;
• adherence to a diet (table number 7), reducing the daily absorption of salt to 1.5-3 g, liquid up to 1 liter with an even distribution, fat consumption is reduced to 0.7-1 g per 1 kg of weight, foods rich in carbohydrates and potassium, fasting days;
• drug therapy: drugs are used to restore protein loss, normalize hemodynamics at the macro and micro levels, sedatives that allow to adjust the activity of the central nervous system, medicines to relieve angiospasm.

To prevent swelling, diuretics are administered in various combinations at the same time or sequentially. If necessary, diuretic agents are prescribed, they should be combined with a sufficient intake of potassium. Only after a full course of therapy and elimination of all symptoms of nephropathy in pregnant women can the question of discharge be raised. But even being at home, you should adhere to the recommendations:

• adhere to the diet prescribed by your doctor;
• take walks in the fresh air in order to better blood supply to the placenta;
• absorb the required amount of liquid;
• avoid stress.

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Treatment outcome

The positive point is that in the treatment of nephropathy of pregnant women, in most cases, natural childbirth is allowed. Caesarean section is prescribed in cases where therapy has not yielded the desired result (for example, high blood pressure is still maintained), and there is a threat of placental detachment or hypoxia. If the use of conservative therapy does not give the desired effect, then there are indications for urgent (urgent) delivery, that is, for a cesarean section.

Childbirth with nephropathy

It is usually possible to cure nephropathy, maintain and achieve a normal completion of pregnancy with proper treatment and adherence to the regimen, as well as all the recommendations of the doctor by the patient. During the birth itself, you need to notify the doctor, carefully monitor the condition of the mother and child, make a competent approach to pain relief and examine the newborn for the possibility of hypoxia. As a rule, already soon after the birth of a child, the woman disappears clear signs of nephropathy: edema, hypertension, kidney function returns to normal.

Prophylaxis

As with all aspects of health, it is important to provide competent prevention aimed at avoiding the development of the disease. Under no circumstances should you miss appointments, examinations and analyzes by a doctor, monitor your own condition on your own. You need to be especially careful in matters of prevention if there is a predisposition, since the likelihood of the manifestation of the disease becomes higher, as does the rapidity of aggravation of symptoms.

If a more complex form of nephropathy has been transferred, then such phenomena as changes in urine and hypertension may also occur in the postpartum period. In such cases, it becomes a question of setting a special control (dispensary), which is set for a year, during which it is supposed to carry out therapy and accounting at least once every 3 months. This control is carried out under the guidance of a therapist and nephrologist. After the expiration of the term, a further decision is made on whether it is worth stopping or extending the dispensary registration, taking into account the results obtained.

In the International Classification of Diseases, 10 revisions of preeclampsia moderate called nephropathy of pregnancy. In the Russian Society of Obstetrician-Gynecologists, this pathology is called gestosis. Symptoms of nephropathy in pregnancy develop after 20 weeks of gestation. The pathology is based on a widespread spasm of microvessels and a violation of the blood supply to internal organs, which entails their failure.

What leads to the development of nephropathy?

An increase in the number of patients with diabetes mellitus, hypertension and overweight women leads to an increase in the frequency of preeclampsia during the period of gestation. It is the main etiological factor in neonatal morbidity and ranks third among the causes of maternal mortality.

In the development of nephropathy, 2 factors play a role:

1. Placental. If, at the time of formation of the placenta, its incomplete germination into the spiral arteries of the uterus occurs, then its insufficient blood supply and ischemia develop. To compensate for this condition, vascular active substances (inflammatory mediators, interleukins, tumor necrosis factor) are released. But gradually they damage blood vessels and pass into the mother's blood. This leads to the development of vascular dysfunction in other organs.
2. The maternal factor is a disease that a woman had before pregnancy and aggravate the damage to the microvascular system. These include diabetes mellitus, arterial hypertension, kidney disease, and fat metabolism disorders.

In some women, nephropathy can be predicted. The following conditions increase the risk:

• chronic stress leads to a frequent release of substances that affect vascular tone, while the adaptive abilities of the body are impaired;
• pregnancy with existing diseases of the cardiovascular system, kidneys, endocrine pathologies (including hyperthyroidism), cholecystitis, hepatitis, vegetative-vascular dystonia and obesity;
• hereditary predisposition, maternal gestosis;
• with diseases of the immune system, increased allergization;
• the age of the pregnant woman is up to 17 years;
• in women who have suffered nephropathy during the previous bearing of a child;
• chronic infections;
• smoking;
• malnutrition.

A deficiency of vitamins, a sedentary lifestyle of a pregnant woman have a great influence on the formation of pathology.

The mechanism of the formation of pathology

The pathogenesis of nephropathy is based on the release of vasoactive substances by the placenta, which leads to generalized vasospasm. In the kidneys, blood flow and glomerular filtration are reduced. This increases serum creatinine. Sodium is retained by the kidneys, while preventing water from leaving. Protein permeability increases and is excreted in urine.

The kidney senses ischemia and, to eliminate the problem, secretes substances that further increase vasospasm. The amount of aldosterone decreases, but vascular permeability increases, which leads to the release of fluid into the tissue and the formation of edema. The volume of the circulating fluid decreases.

All kidney functions are gradually disrupted: hormonal, excretory, filtration, resorption and regulatory, the amount of protein in the urine increases.

Classification

The classification of nephropathy is based on clinical manifestations. It is characterized by edema varying degrees severity. Dropsy of pregnant women can be hidden and visible.

Explicit edema is divided into 4 degrees:

1. Swelling of the legs.
2. Lower limbs + abdomen.
3. Accession of edema of the face.
4. Anasarka, total edema.

The severity of nephropathy itself is assessed using the Savelyeva scale. Each pathological condition is assigned its own number of points, their sum is an indicator of severity. Grade 1 nephropathy of pregnant women - up to 7 points, moderate severity - 8-11 points, severe nephropathy - 12 or more.

Concomitant diseases are those that worsen the condition and increase the risk of developing pathology.

Manifestations of nephropathy

The main clinical signs that distinguish nephropathy of pregnant women from mild preeclampsia are the classic triad:

1. Swelling.
2. Proteinuria.
3. Arterial hypertension.

Symptoms do not appear all at once, usually there is a gradual addition of signs of nephropathy. Edema is often the first to appear. Sometimes this is a latent form of dropsy, which can be suspected of pathological weight gain. Weight increases by 600 g or more per week. The systolic pressure rises by 20-30 mm Hg. Art. from the original, and diastolic by 15 mm Hg. Art. After a while, proteinuria joins the first symptoms. Sometimes the classic triad of signs is not observed, one or two of them appear in a pregnant woman.

With the normal progression of pregnancy, blood pressure practically does not change. In women with preeclampsia, a significant increase in pressure can lead to overloading of the left ventricle of the heart and the development of pulmonary edema.

Symptoms accompanying nephropathy in pregnant women

If nephropathy develops against the background of previously existing hypertension, then its course is more aggressive and quickly reaches 3 degrees. An isolated rise in only diastolic pressure with a low systolic pressure is considered an unfavorable phenomenon that deserves special attention.

Increased pressure leads to characteristic changes in the fundus. In this case, the following signs are observed:

• swelling of the nipple of the optic nerve;
• spasm of arterioles;
• traces of hemorrhage.

Sometimes with pronounced pathological conditions fundus can be decided on early delivery. But if the pressure returns to normal, then the pathological changes disappear. Preservation of signs of eye pathology persist with existing chronic pyelonephritis or hypertension.

Protein in the urine can be combined with traces of red blood cells (microhematuria) or cylindruria. If hematuria is significantly pronounced, then nephropathy is combined with glomerulonephritis.

Mild nephropathy of pregnant women can aggravate its course, while additional symptoms appear:

• headache;
• drowsiness or a state of agitation;
• dyspeptic disorders in the form of nausea, vomiting;
• behavioral disorder, irritability, tearfulness, frequent mood swings;
• impairment of vision, hearing, speech;
• feeling of heat.

The appearance of a hoarse voice, difficulty in nasal breathing, coughing speaks of widespread edema and is an unfavorable sign. Itchy skin, the appearance of rashes of pain in the right hypochondrium - evidence of liver damage.

The fact that a condition of 2 severity is progressing and is at risk of becoming eclampsia is indicated by the following symptoms:

• impaired consciousness of varying severity, an extreme condition is a coma;
• detachment of the retina and a sharp drop in vision;
• acute renal failure;
• respiratory failure and signs of pulmonary edema;
• acute liver failure and HELLP syndrome;
• premature placental abruption;
• cerebral hemorrhage;
• convulsions.

Nephropathy after childbirth, if it does not occur against the background of pre-existing hypertension and kidney disease, usually goes away and does not lead to the persistence of severe symptoms. Otherwise, the disease can aggravate its course.

Complications associated with nephropathy

Pathological conditions that occur during pregnancy affect the condition of the fetus. Complications can be as follows:

• intrauterine growth retardation in combination with feto-placental insufficiency;
• fetal asphyxia and hypoxia, which can result in antenatal loss of the child;
• premature detachment of a normally located placenta;
• premature delivery or spontaneous interruption of gestation up to 22 weeks.

The consequences of nephropathy in pregnant women are manifested in labor disorders. Blood pressure can begin to rise during labor, leading to abnormalities in labor. During childbirth and the postpartum period, the risk of bleeding increases.

Methods for diagnosing the disease

At each visit to the gynecologist, a pregnant woman is prescribed a urine test, blood pressure is measured and the presence of edema on the legs is shown. Weighing is mandatory. These simple tricks allow you to notice pathological symptoms at an early stage and to carry out appropriate treatment.

The results of all measurements are entered into the pregnant card. This allows you to dynamically monitor the course of pregnancy.

When the first symptoms of nephropathy appear, an additional examination is performed to determine the degree of pathological changes:

• coagulogram;
• Ultrasound of the kidneys, liver;
• blood chemistry;
• measurement of daily urine output;
• fetal cardiotocography after 27 weeks of gestation;
• Ultrasound of the fetus and determination of uteroplacental blood flow;

In many cases, an examination by an ophthalmologist is appointed, who assesses the condition of the fundus. According to the indications, a consultation is carried out with a nephrologist, endocrinologist, cardiologist. Other diagnostic methods may be used depending on the specific case.

Treatment methods

Treatment of nephropathy of pregnancy is determined by the severity. At 1-2 degrees, hospitalization is needed in the department of pregnancy pathology. For severe nephropathy, treatment is carried out in the intensive care unit.

In the conditions of the maternity hospital, a therapeutic and protective regime is created, which allows to reduce the load on nervous system... Be sure to adhere to bed rest and a general decrease in physical activity. A woman needs good sleep and rest.

The diet should be balanced. The daily salt intake is necessarily limited to 3 g, the amount of liquid is reduced to 1.3-1.5 liters. This takes into account all drinks, soups, juicy fruits.

Medication includes medications to lower blood pressure. For this, intravenous drip infusion of a solution of magnesium sulfate is carried out. It has a hypotensive effect, reduces the tone of the uterus, improves placental blood flow.

To reduce vasospasm, antispasmodics are prescribed: Drotaverin, Papaverine, Platifillin. Diuretics that are administered after a dropper, for example, Furosemide, Hydrochlorothiazide, help to reduce swelling.

Under the control of a coagulogram, antiaggregants and anticoagulants are prescribed to improve the rheological properties of blood. It can be Aspirin in small doses, Dipyridamole, Pentoxifylline. The duration of their use is determined individually.

Correction of metabolic and electrolyte disorders, restoration of organ blood flow, the amount of protein is carried out through infusion therapy. Plasma infusion helps maintain sufficient clotting factors to prevent bleeding. Correction of the electrolyte composition occurs due to the solutions of Polyglyukin, Reopoliglyukin, Ringer, dextrose, saline solutions.

Herbal treatment for nephropathy in pregnant women is supportive and distracting. Traditional methods not able to affect pathological changes in the vessels. When using only herbal medicine, the risk of the disease becoming a serious condition increases.

The choice of delivery time depends on the effectiveness of the treatment. With mild nephropathy, treatment is carried out within 2 weeks. If it does not have a pronounced effect, then termination of pregnancy is indicated.

Treatment of moderate nephropathy is carried out for 5-6 days. Severe nephropathy is subject to emergency treatment in the intensive care unit. If there is no effect of treatment within 3-12 hours, then emergency delivery is indicated. For this, a caesarean section is performed, in which endotracheal anesthesia is used.

Prevention of gestosis and its complications

So that the symptoms of nephropathy do not come as a surprise, timely prevention is necessary. It should be started before conception with examination and elimination of the pathology of the cardiovascular system, treatment of chronic kidney disease, diabetes mellitus. It is necessary to achieve a stable remission of these pathologies. For overweight women, a diet to reduce weight is recommended.

During pregnancy, a woman should get enough rest and not go to bed too late. But at the same time, one must not forget about motor activity... You can do some gymnastic exercises on your own or in schools for pregnant women.

Nutrition for the period of gestation should be balanced in terms of essential nutrients. Additionally, take multivitamin complexes. Restriction of table salt is imperative. It is recommended to cook dishes without salt, and add salt directly on your plate.

Women from risk groups for the formation of nephropathy at a critical time are prescribed drugs that improve placental blood flow, reduce tone. This is Curantil, Magne B6.

Pregnant women need to follow all doctor's instructions. If the therapy is effective, then the pregnancy is prolonged until the maturity of the fetus. After suffering severe nephropathy, a woman should be followed up for a year by a therapist. This is necessary in order to timely treat the consequences of pathology in the form of a persistent increase in pressure, kidney damage, changes in the fundus. Subject to the doctor's prescriptions and proper treatment, the prognosis for nephropathy is favorable.

In contact with

nephropathy of pregnant women - late gestosis, characterized by a triad of symptoms (Zapgenmeister's triad): edema, arterial hypertension, progeituria.

Sometimes the symptoms of nephropathy are of equal severity. It is possible to determine the severity of nephropathy by the severity of one of the symptoms of the triad.

Nephropathy often occurs against the background of previous diseases (kidney disease, hypertension, obesity, endocrinopathy).

To assess the severity of gestosis, the Wittlinger scale is used, which makes it possible to objectify some clinical signs:

1. Edema: absent - 0 points, localized - 2 points, generalized - 4 points.

2. Weight gain: up to 12 kg - 0 points: 1215 2 points: more than 15 kg - 4 points.

3. Proteinuria: absent 0 points, up to 1 gram per day - 2 points, 3 grams per day - 4 points: more than 3 grams - 6 points.

4. Blood pressure:

below 135/80 -0 points, 135/85 - 140/90 -2 points, 140/90 - 160 100 - 4 points, above 160/100 - 8 points.

5. Diuresis: more than 1000 ml per day - 0 points, 400 - 1000 ml per day - 4 points, less than 400 ml per day - 6 points, anuria within 6 hours - 8 points.

6. Subjective symptoms: absent - 0 points: available - 4 points.

The total score gives an idea of ​​the severity of gestosis

2 - 10 points - mild degree;

10 - 20 points - average:

more than 20 points - severe nephropathy.

examination plan for nephropathy:

1.Inquiry (identification of complaints, the presence of concomitant diseases)

2. Objective examination:

dynamic monitoring of body weight gain;

determination of the presence of edema:

measurement of blood pressure on both hands.

3.Additional research:

KLA - hematocrit more than 0.42 - severe preeclampsia. Urine examination:

general analysis - proteinuria, cylindruria,

study of the daily portion of urine - determination of daily protein loss;

Zimnitsky's test - allows you to identify a decrease in urine output, changes in the relative density of urine during the day, the distribution of urine output during the day;

blood chemistry:

an increase in urea and creatinine in the blood plasma indicates a violation of the nitrogen-excreting function of the kidneys: hypoproteinemia, a decrease in the colloid-oncotic plasma pressure indicates liver damage;

fundus examination - signs of hypertensive retinopathy;

study of hemodynamics decrease in BCC. decrease in CVP and PVP (peripheral), decrease in cardiac output, increase in systemic vascular resistance. metabolic disorders in the myocardium.

Treatment.

1. If at least one of the signs of nephropathy is detected, the pregnant woman should be hospitalized in the OPB.

Patients with moderate and severe nephropathy should be placed in the pathology department of highly qualified obstetric hospitals at multidisciplinary hospitals with anesthetic and intensive care and conditions for nursing newborns.

2.If there is a suspicion of concomitant gestosis (arising against the background of other diseases - neuro-metabolic-endocrine syndrome, kidney disease, hypertension), the examination is carried out with the advice of the relevant specialists.

3. Creation of a medical and protective regime:

a protein-plant diet with salt and fluid restriction,

good sleep and rest,

non-drug methods - IRT. Elekfoson,

drug methods - sedatives (tincture of motherwort, valerian), small tranquilizers (fioxazin, nosepam, etc.). These drugs have a calming effect, suppress feelings of anxiety, internal tension, reduce anxiety;

in order to enhance the sedative effect of tranquilizers, the latter are prescribed together with antihishamines (diphenhydramine, diprazine).

4. Elimination of vasospasm:

antispasmodics - papaverine, no-shpa, dibazol, aprofen;

aminophylline has antispasmodic and hypotensive properties, improves renal blood flow,

magnesium sulfate has a diuretic effect, has an anticonvulsant effect.

5. Elimination of hypovolemia

infusion therapy, including onco- and osmoactive drugs (plasma). antiplatelet agents (rheopolyglucin, hemodez.albumin),

glucose-novocaine mixture.

Normalization of vascular permeability:

oral rutin, askorutin, ascorbic acid:

7. Normalization of rheological and coagulation properties of blood:

oral antiplatelet agents (courantil);

infusion therapy, including angicoagulants and deagretanges - heparin, heparin-rheopolyglucin mixture.

8. Normalization of metabolism:

Multivitamins,

Panangin orally or intravenously.

correction of disturbed acid base balance (intravenous sodium bicarbonate, tosamin. lactosol). 9.oxidant therapy:

tocopherol acetate:

glutamic acid.

10.Prevention and treatment of intrauterine fetal hypoxia, improvement of uteroplacental blood circulation:

glucose-novocaine mixture:

5% glucose solution:

rheopolyglucin with heparin and others.

11.Time of treatment:

mild nephropathy, as a rule, amenable to therapy in a hospital setting. You should monitor the numbers of blood pressure, body weight, urine output,

moderate nephropathy - to achieve compensation, it can be treated for 7 days. With an increase in the duration of treatment, the risk of complications increases significantly:

severe nephropathy - if no compensation occurs within 24 hours of treatment, complications may develop.

12. In the absence of the effect of the therapy for moderate and severe nephropathy, the development of complications, it is necessary to terminate the pregnancy.

Often, pregnant women are diagnosed with nephropathy: consider what it is, what is this disease and what manifestations is it characterized by? This is one of the forms of late toxicosis, caused by the fact that a woman has problems with the capillaries of the kidneys. As a result, edema appears, proteinuria syndrome occurs (the presence of protein in the urine), hypertension is noted, oliguria is observed (a decrease in the daily dose of urine). The disease most often occurs against the background of severe pathologies and diseases - heart disease, diabetes mellitus (diabetic nephropathy), pyelonephritis, dropsy.

Nephropathy during pregnancy can proceed in different ways, depending on the reasons that triggered its development.

• dysmetabolic nephropathy during pregnancy is caused by impaired metabolism in a woman's body, when harmful metabolic products accumulate in the placenta and uterus, which then settle in the kidneys and damage the renal glomeruli;
• hormonal imbalance;
• immunological conflict between the mother's body and the fetus's body;
• dysfunctions of the central nervous system;
• multiple pregnancy, first pregnancy;
• hypertension, obesity, heart disease, glomerulonephritis,;
• diabetic nephropathy during pregnancy is caused by a serious illness that a woman suffered from even before conceiving a child - diabetes mellitus.

If the cause of nephropathy is determined correctly, the treatment of the disease will be aimed at eliminating it, as well as eliminating the symptoms of the disease, taking into account the safety of drugs for the baby.

Symptoms of nephropathy during pregnancy

Usually, the main symptoms of nephropathy during pregnancy appear after the twentieth week of bearing a child. These include:

• arterial hypertension: first, diastolic pressure rises, after a month - systolic;
• hyperuricemia - an increased content of uric acid is found in the urine;
• proteinuria - during the tests, protein in the urine is detected, the content of which is rapidly increasing and contributes to the formation of nephrotic syndrome;
• swelling of the face and hands;
• headache begins to torment, insomnia at night, mood worsens up to complete indifference to everything, apathy arises;
• vision may deteriorate;
• nausea often appears.

Depending on the severity of the symptoms, nephropathy is conventionally divided into 3 stages:

• Grade 1 (sometimes called stage I, or simple nephropathy) differs in that the symptoms of the disease are mild, almost imperceptible, and a woman most often perceives mild malaise as a common condition for such a situation; identifying the disease at this stage allows you to take the necessary measures and prevent premature, which often ends with the treatment of other, more severe forms of the disease;
• Grade 2 (stage II, or preeclampsia) is characterized by a noticeable deterioration in the woman's condition, in which she can independently suspect signs of the disease;
• Grade 3 (stage III, or eclampsia) forces you to immediately consult a doctor, since the woman's condition is too critical and can lead to a miscarriage.

The deterioration of the condition of the expectant mother with nephropathy is most often very noticeable and pronounced (the exception is nephropathy of the 1st degree), therefore, it is necessary to report all symptoms to the doctor as soon as possible. This will help to make the correct diagnosis, prescribe timely treatment and hospitalize the patient.

Treatment of the disease

Treatment of nephropathy in pregnant women involves hospitalization, as bed rest and constant medical monitoring of changes in pressure and kidney function are prescribed. Antihypertensive and anticonvulsant therapy is carried out by prescribing drugs that are safe for the health and development of the fetus:

• magnesium sulfate is preferable to modern antipsychotics (droperidol) and tranquilizers (seduxen), since it is safer for the child, it can be prescribed intramuscularly or intravenously;
• to relieve a hypertensive crisis, hydralazine is prescribed;
• diazoxide, obzidan are undesirable, but if there is no reaction to other drugs, they are prescribed with caution in small doses;
• diuretics (spironolactone, saluretics) are prescribed to eliminate pulmonary or cerebral edema, but they can lead to all kinds of pregnancy complications with prolonged, systematic use.

Pregnant women are contraindicated in sodium nitroprusside, reserpine, ganglion blockers, octadine, captopril. Treatment of nephropathy during pregnancy continues until the birth of a viable, healthy fetus becomes possible. With the progression of the disease and the occurrence of additional complications, a decision is made on urgent delivery, which is considered one of the methods of treating severe forms of nephropathy in pregnant women.

Nephropathy of pregnancy is a deterioration in the condition of a woman in the second or third trimester of pregnancy, which is characterized by impaired function of blood vessels and renal excretory ability.

The main manifestations of toxicosis in late pregnancy are:

• persistent increase in blood pressure values;
• the appearance of both external and internal edema;
• excretion of protein from the body by the kidneys.

Causes of occurrence

To date, there are no clinically proven factors that directly affect the appearance of late toxicosis.

But scientists agree that, most likely, this condition during pregnancy is caused by the excessive work of the mother's immune system. In this case, the deposition of immune complexes in the capillaries of the renal glomeruli occurs, which significantly reduces their filtering and excretory capacity - fluid retention in the body begins, renal pressure rises, etc. An increased production of antibodies can occur with an immune conflict between the mother's body and the child's body.

It can also serve as the cause of nephropathy in pregnant women and a violation in the nervous regulation of blood circulation processes and the production of certain substances responsible for the condition of the walls of blood vessels. In this case, a spasm of the arteries and a significant narrowing of their diameter occurs, the general blood flow is disturbed. But most of all, the capillary network suffers from this, which nourishes the placenta and the internal tissues of the kidneys.

With nephropathy, the risk of thrombus formation significantly increases, which is fraught with the occurrence of internal bleeding and impaired blood supply to tissues

In any case, regardless of the root cause, the following manifestations occur:

• the kidneys begin to remove protein from the body (which should not normally be);
• the walls of the vessels become more permeable, as a result of which part of the plasma leaves the bloodstream (into the muscles and tissues) - edema appears;
• narrowing of the arteries causes varicose veins and blood congestion. Because of this, all internal organs and tissues are affected;
• damage to the cells of the heart, myocardium and central arteries can lead to heart failure;
• the capillaries of the renal glomeruli are clogged with immune complexes, which is fraught with renal failure;
• oxygen deficiency of the fetus occurs.

In some cases, the causes of nephropathy in pregnant women are known in advance. These include predisposing diseases that a woman had before pregnancy:

• diabetes;
• glomerulonephritis;
• chronic pyelonephritis;
• congenital or acquired heart defects;
• hypertension.

In addition, there are additional risk factors. So, more often than the rest, late toxicosis manifests itself in women:

• overweight;
• during the first pregnancy;
• if the woman's age is less than 18 years old and more than 36 years old;
• with multiple pregnancies;
• if nephropathy occurs in previous pregnancies;
• if you have bad habits, especially smoking.

In order to prevent the onset of late toxicosis, it is necessary to get rid of bad habits even at the stage of pregnancy planning.

If there are any reasons that contribute to toxicosis in late pregnancy, a woman should more closely monitor the blood pressure level over time and monitor the appearance of external edema in order to promptly inform the doctor about it.

Types and classification

Regarding the root cause of the onset and the presence of systemic diseases, there are:

• the primary form (when a woman does not have common diseases);
• the secondary form (if nephropathy has arisen due to the presence of predisposing diseases).

The classification of nephropathy involves the allocation of the severity of the disease.

According to the severity of the symptoms, the condition is subdivided into:

• nephropathy 1 degree. The patient's condition is assessed as satisfactory. There is a small amount of protein in the urine, blood pressure does not rise above 150/90 mm Hg, edema is observed only in the leg area;
• nephropathy of the 2nd degree. The general condition of the woman is deteriorating. The pressure rises to 170/100 mm Hg, edema is present not only on the legs, but also in the abdomen, less often the lower back;
• nephropathy 3 degrees. The pregnant woman is in serious condition, treatment is carried out in the intensive care unit. The pressure level exceeds 180/110 mm Hg, swelling of almost all parts of the body is observed, protein in the urine is present in large quantities.

Even with a single occurrence of high blood pressure in the second or third trimester of pregnancy, a woman should be under constant medical supervision.

The progression of the course of the disease without taking the necessary measures occurs rather quickly (from 1 week to several hours).

Symptoms

The main three signs of nephropathy in pregnant women are considered to be:

• high blood pressure;
• detection of protein in urine tests;
• swelling of the limbs, the anterior wall of the peritoneum, face, lower back.

When assessing the level of pressure, the diagnostic and prognostic role is primarily diastolic. If its level after the 20th week of pregnancy is higher than 90 mm Hg, then an urgent need to consult a doctor.

The appearance of even an insignificant content of protein in the urine requires careful observation and repeated tests over time. The fact is that with nephropathy, the amount of excreted protein can grow very quickly, which is dangerous for the health of the mother.

A distinctive feature of external edema in nephropathy is their spread from lower limbs(with light severity) up, up to the face (at a later stage).

Symptoms of nephropathy in pregnant women can be observed both jointly and separately.

The presence of even one manifestation should force a woman to see a doctor.

In addition to the main clinical picture, additional symptoms may be present:

• decrease in the daily volume of urine excreted;
• dyspnea;
• deterioration of the nervous state (apathy, lethargy, up to coma);
• decrease in the level of vision;
• headache, dizziness;
• nausea;
• deterioration in sleep quality, insomnia.

If the blood supply to the liver is disturbed, then there is pain in the right middle quadrant of the abdomen, sometimes yellowness of the sclera.

Diagnostics

A pregnant woman, throughout the entire period of bearing a child, should carefully monitor all changes in her well-being, so that, if necessary, consult a doctor as early as possible.

First of all, a pregnant woman should be alerted to the systematic appearance of edema, especially if they are noticeable not only in the leg area, but also on the hands or face.
Measurement of the blood pressure level in dynamics also refers to diagnostic measures in the detection of nephropathy in pregnant women. It is best to take the measurement at the same time every day after a short rest. And if hypertension is suspected, the frequency of measurements increases up to 3-4 times a day in order to control the condition.

The frequency of urination and the volume of urine excreted also serve as indicators of the condition of a pregnant woman. If the daily amount of fluid withdrawn sharply decreases, then this is a reason to urgently consult a doctor, since such a symptom indicates impaired renal function.

A delay in the excretion of fluid by the kidneys can manifest itself as excessive weight gain and the formation of edema of internal tissues

It is also necessary to systematically evaluate the results of clinical analyzes and hardware diagnostic methods:

• Analysis of urine. If a protein is detected, re-analysis is performed on a fresh portion of urine to determine the rate of progression of the condition. If leukocytes, erythrocytes or bacteria are also found in the urine, then kidney disease must be excluded;
• CTG of the fetus to assess the heartbeat and identify possible hypoxia;
• Doppler ultrasonography of the renal and placental vessels (blood flow velocity is measured);
• Fetal ultrasound;
• ECG to detect possible abnormalities in the work of the heart;
• blood chemistry.

Even if nephropathy is suspected, a woman should undergo a fundus examination. This is due to the fact that spasm of the arteries and an increase in the lumen of the veins can lead to minor hemorrhages, which is fraught not only with a temporary deterioration in vision, but also with retinal detachment.

Starting from the 20th week of pregnancy, a woman should visit a gynecologist at least 1 time in 10 days, and with the onset of the third trimester, the frequency increases to 1 time in 7 days. Such measures are aimed at identifying possible signs that threaten the health of the mother and baby. In this case, weight gain is monitored and anamnesis is collected. If a large weight gain is detected, then even without visible signs, the doctor may suspect the presence of internal edema.

In addition to consultations with a gynecologist, therapist and ophthalmologist, you may need to visit a urologist, endocrinologist, cardiologist.

It should be remembered that nephropathy during pregnancy only in half of the cases is manifested by three symptoms at once (hypertension, edema and the detection of protein in the urine). Therefore, even with minor changes in her well-being, a woman in this exciting period of her life should consult a doctor.

Treatment

Treatment of nephropathy during pregnancy, even in a mild form of severity, should take place only in a hospital setting.

The principle of therapy for this condition is aimed at eliminating negative manifestations and replenishing protein loss.

Throughout the treatment, constant monitoring of the level of blood pressure is carried out

For the first at least 3 days, a woman must comply with complete bed rest with the exclusion of stress factors.

The diet during treatment will consist of protein foods, vegetables, meals high in potassium and carbohydrates. The intake of salt and animal fats is limited.

The drinking regimen is negotiated with the doctor separately, but usually the daily volume of fluid should not exceed 1 liter.

Drug therapy consists of taking:

• light sedatives;
• antispasmodics (to relieve angiospasm of the arteries);
• diuretics or diuretic decoctions (to reduce the severity of edema);
• antiplatelet agents (to reduce the risk of blood clots);
• drugs that normalize blood pressure levels.

The duration of hospital stay with mild to moderate nephropathy usually does not exceed 10 days.

If the measures taken do not have the desired effect and the woman's condition does not stabilize, then a decision may be made about emergency delivery.

It is preferable to use the method caesarean section, which allows you to monitor the condition of the mother and baby

If nephropathy is amenable to therapy, then spontaneous delivery is possible without any consequences in due time.

After childbirth, all symptoms of nephropathy of pregnant women disappear spontaneously, after 1-2 days.

Potential consequences and complications

Nephropathy during pregnancy is dangerous not only for the health of the mother, but also for the condition of the fetus.

So, a woman may experience:

• renal failure;
• retinal disinsertion;
• placental abruption;
• internal bleeding;
• heart failure.

All conditions are quite dangerous and can threaten the life of the expectant mother.

The fetus's body suffers no less. The greatest danger is hypoxia (oxygen starvation), which is fraught with:

• lag in intrauterine development;
• death of brain cells;
• dysfunction of the kidneys and other organs.

Lack of treatment for nephropathy can result in spontaneous abortion, fetal or maternal death.

Nephropathy of pregnancy can progress rather quickly from a mild to a serious condition, posing a threat to the life and health of the mother and child. Therefore, at the first signs of this condition, it is necessary to urgently consult a doctor.