Nephropathy of pregnant women
Nephropathy of pregnant women – the clinical form of late toxicosis including a triad of symptoms in typical cases: hypostases, arterial hypertension and proteinuria. Sometimes the nephropathy of pregnant women is shown by two called symptoms; seldom, at a monosimptomny current – one (hypertensia or a proteinuria). Diagnostics of a nephropathy of pregnant women is based on detection of the obvious and latent hypostases, raised HELL, a squirrel in urine in the III trimester of pregnancy. Treatment of a nephropathy of pregnant women is carried out in an obstetric hospital and includes purpose of the guarding mode, diet, hypotensive, diuretichesky, sedatives.
Nephropathy of pregnant women
The pathological states which are arising in the second half of a gestation and passing later termination of pregnancy or childbirth belong to late toxicosis of pregnancy (gestoza). The gynecology carries dropsy, a nephropathy of pregnant women, a preeklampsiya and an eklampsiya which at the same time are stages of one pathological process to late toxicoses. Usually late toxicosis begins with dropsy (hypostases), then can pass into a nephropathy of pregnant women, a preeklampsiya and an eklampsiya. Transition of one form of toxicosis to another can be gradual, with aggravation of symptomatology, or very bystry, lightning.
Distinguish primary nephropathy which developed at pregnant women with not burdened somatic anamnesis, and the combined late toxicosis arising against the background of earlier existing pyelonephritis, a glomerulonefrit, a hypertension, heart diseases (a secondary nephropathy of pregnant women). Among factors of perinatal child and maternal mortality the nephropathy of pregnant women is one of the main reasons. Frequency of development of a nephropathy of pregnant women according to various researches fluctuates in the range of 2,2-15,0%.
Reasons of a nephropathy of pregnant women
It is considered that emergence of a nephropathy is connected with insolvency of adaptable mechanisms of an organism of the pregnant woman to the new state. The nephropathy of pregnant women is characterized by a generalized spasm , change of haemo dynamics, increase in vascular permeability, decrease in OTsK, violation of microcirculation of vitals that leads to a hypoxia, disorders of metabolism, first of all, to violation of water-salt and proteinaceous exchange.
There are several hypotheses explaining the reasons of development of a nephropathy of pregnant women. One of theories as a decisive factor puts forward the moment of accumulation in an ischemic placenta and a uterus of harmful products of exchange. Among toxic metabolites there are anti-genes causing formation of complexes an anti-gene antibody with their subsequent subsidence in kidneys and damage of kidney balls. Besides, the placenta begins to produce substances-vazopressory which lead to a widespread spasm . It is not excluded that the tromboplastina coming from an ischemic placenta to the general blood-groove, provoke development of the DVS-syndrome which is followed by repeated tromboemboliya of vessels of kidneys and lungs.
Other theory of development of a nephropathy of pregnant women is based on a hypothesis of violation of hormonal balance. The metabolism products collecting in an ischemic placenta and a uterus stimulate production of prostaglandins and vazokonstriktor, hormones of adrenal glands (an aldosteron, catecholamines), synthesis with kidneys of hormone of a renin and its ekstrarenalny production the uterus and a placenta.
The essential part in development of a nephropathy of pregnant women is assigned to the immunological conflicts between organisms of mother and a fruit with formation of the CEC including IgG, IgM, C3-komplementa fraction. On this background in an organism of the pregnant woman biologically active agents - acetylcholine, a histamine, serotonin, etc. are produced.
In emergence of a nephropathy pregnant as an important point serves malfunction of TsNS what the changes of EEG of a brain noted even before development of symptoms of toxicosis testify to. The nephropathy of pregnant women develops at the first pregnancy, a mnogoplodiya more often. The hypertension, obesity, heart diseases, diabetes which are earlier postponed pyelonephritis also glomerulonefrit contribute to development of a nephropathy of pregnant women.
The circulator violations developing in kidneys lead to a delay of liquid and sodium in fabrics (hypostases), emergence of protein in urine (proteinuria), and excess emission of a renin in blood - to a steady vascular spasm and increase HELL. At a nephropathy of pregnant women the myocardium, a liver, brain vessels also suffer. Owing to violation of placentary blood circulation the hypotrophy and a hypoxia of a fruit can develop.
Symptoms of a nephropathy of pregnant women
The nephropathy of pregnant women develops, as a rule, after the 20th week of pregnancy. Its emergence is preceded by the dropsy of pregnant women which is characterized by emergence of the latent and obvious persistent hypostases at normal HELL and lack of protein in urine. At adverse development dropsy passes into the following stage of toxicosis – a nephropathy of pregnant women.
The progressing arterial hypertension with increase at first diastolic, and then and systolic HELL is a constant sign of a nephropathy of pregnant women. In 3-6 weeks after detection of hypertensia the proteinuria accrues. Expressiveness of hypostases varies from small pastosity of hands and the person to extensive puffiness of all body. On degree of expressiveness of symptoms distinguish 3 severity of a nephropathy of pregnant women.
At the I degree HELL is not higher than 150/90 mm of mercury.; the proteinuria makes up to 1 g/l; hypostases on the lower extremities are noted. The II degree of a nephropathy of pregnant women is characterized by increase HELL to 170/110 mm of mercury. (with a pulse difference not less than 40); a proteinuria to 3 g/l, emergence of hyaline cylinders in urine; hypostases on the lower extremities and in the field of a forward belly wall; a diuresis not less than 40 ml an hour. At the III degree of a nephropathy of pregnant women HELL increases more than 170/110 mm of mercury. (with a pulse amplitude less than 40); the proteinuria exceeds 3 g/l, in urine granular cylinders are found; hypostases become generalized; the diuresis decreases less than 40 ml for an hour.
Also at a nephropathy of pregnant women thirst, dizziness, a bad dream, weakness, short wind, dyspepsia, a meteorizm, deterioration in sight, waist pain is noted. At damage of a liver there are pains in the right podreberye, increase in the sizes of a liver, jaundice sometimes develops. In case of damage of a myocardium development of an ischemic miokardiopatiya is noted.
At the early beginning and a long current of a nephropathy of pregnant women of a high probability of its transition to the following stages – a preeklampsiya and an eklampsiya. The nephropathy of pregnant women can lead to spontaneous termination of pregnancy, a fruit arrest of development, a premature otsloyka of a placenta, a hypoxia or asphyxia of a fruit, the premature and complicated childbirth (anomalies of patrimonial activity, bleedings).
Diagnostics of a nephropathy of pregnant women
The nephropathy of pregnant women is revealed by the gynecologist observing the woman on characteristic symptoms. At the same time the classical triad of a nephropathy occurs only at 50-60% of pregnant women, at the others existence of one or two signs is possible.
Recognition of a nephropathy of pregnant women is promoted by competent conducting pregnancy with regular measurement HELL, dynamic control of an increase of body weight, scoping of a diuresis, a research of the general analysis of urine. Doppler sonography of a uterine and placentary blood-groove, a kardiotokografiya, a fruit phonocardiography, obstetric ultrasonography is made for specification of a condition of a placenta and a fruit. At a research of an eye bottom signs of narrowing of arteries and expansion of veins are found in women with a nephropathy of pregnant women.
The nephropathy of pregnant women is differentiated with pyelonephritis, glomerulonefrity, symptomatic hypertensia, tumors of adrenal glands (feokhromotsitomy, Conn's syndrome). Experts the oculist, the nephrologist, the endocrinologist, the neurologist, the cardiologist can be involved in diagnostics of a nephropathy of pregnant women. In addition performing ultrasonography of kidneys and adrenal glands, the ECG, biochemical blood test and urine, a koagulogramma, bakposev of urine, definition of hormones can be required (a renin, an aldosteron, catecholamines).
Treatment of a nephropathy of pregnant women
At a nephropathy hospitalization is required; at I and II degrees – in the general office of pathology of pregnant women, at the III degree - in ORIT. In a hospital careful monitoring HELL, contents of electrolytes, functions of kidneys is carried out.
Indispensable condition of treatment is observance of medical and guarding measures: bed rest, good rest and dream, reception of sedative medicines. The diet at a nephropathy of pregnant women consists in restriction of daily consumption of salt to 1,5-2,5 g, liquid - to 1 l, fats. At a daily diet there has to be enough protein, the fruit, vegetables, products rich with potassium and carbohydrates. Fasting days are weekly spent (kefiric, sukhofruktovy cottage cheese, etc.).
Medicamentous therapy is directed to removal of an angiospazm, normalization micro and macrohaemo loudspeakers, compensation of loss of protein. At a nephropathy pregnant medicines of the first row are spazmolitik (a papaverine, , ), hypotensive means (magnesias sulfate), diuretics, potassium medicines, antiagregant (), proteinaceous medicines (plasma, albumine), etc. Infusional therapy at a nephropathy of pregnant women is carried out under control of OTsK, a diuresis, a gematokrit, electrolytes. At a nephropathy of pregnant women sessions of a girudoterapiya, oksigenobaroterapiya can be appointed. At inefficiency of conservative treatment of a nephropathy (in techeniye1-2 weeks at the I Art. and 1-2 days at the III Art.) the pregnant woman needs an urgentny rodorazresheniye.
The forecast at a nephropathy of pregnant women
At observance of the mode and adequacy of therapy the nephropathy of pregnant women usually gives in to treatment. In case of knocking over of the phenomena of a nephropathy pregnancy manages to be kept. In the course of childbirth monitoring of a condition of a fruit and the woman in labor, careful anesthesia, prevention of a hypoxia of a fruit is required. In the subsequent inspection of the newborn regarding a pre-natal hypoxia, intensive observation of a neonatolog is necessary. After the delivery at the woman hypostases, hypertensia, a proteinuria disappear, work of kidneys is restored.
Early appearance and persistent current of a nephropathy of pregnant women predictively is adverse for a fruit and mother. Resistant forms of a nephropathy quite often pass into a preeklampsiya and an eklampsiya which can end with pre-natal death of a fruit and the death of the pregnant woman.
Prevention of a nephropathy of pregnant women
During conducting pregnancy systematic observation for HELL, a body weight increase, secretory function of kidneys of the pregnant woman, timely detection and knocking over of initial displays of toxicosis is necessary. Pregnant women with the ekstragenitalny pathology serving as a background for development of a nephropathy need especially careful observation of the obstetrician-gynecologist.