July 10th, 2020

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ted Renal Failure and Metabolic Acidosis During Pregnancy: A Unique Insight Into Natural History of the Disease: A Case Report
Authors:  Sara Jane Cromer, M.D., Karen S. Sargent, M.D., Steven Clark, M.D., and Catherine S. Eppes, M.D., M.P.H.
BACKGROUND: End stage renal disease (ESRD) during pregnancy is typically treated with frequent dialy-sis. For this reason, experience with medically monitored but untreated progressive renal failure is rare. When this disease is left untreated, complications such as severe anion gap metabolic acidosis (AGMA) can have profound maternal and fetal effects and present challenges to labor management.

CASE: We present a unique case in which a pregnant woman with focal segmental glomerulosclerosis refused dialysis during her pregnancy. She presented to labor and delivery with profound AGMA, fetal growth restriction, and severe preeclampsia and required urgent delivery, intubation, and postpartum dialysis. Her neonate had a well-compensated metabolic acidosis, elevated BUN/Cr, and thrombocytopenia.

CONCLUSION: Untreated ESRD and resultant metabolic acidosis during pregnancy and at delivery dictate a complex, team-based management scheme. This case allows rare insight into natural history and clinical consequences of progressive renal failure in pregnancy and may assist in its management.
Keywords:  end stage renal disease, kidney disease, metabolic acidosis, pregnancy complications, renal failure in pregnancy, severe chronic kidney disease
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