Antiangiogenic factors and maternal hemodynamics during intensive hemodialysis in pregnancy

We report on a 21‐year‐old pregnant patient with IgA nephropathy who was initiated on intensive hemodialysis (8 hours of hemodialysis 3 times a week) at a gestational age of 26 weeks on the basis of worsening kidney function resulting in rapidly progressive fatigue and difficulties in metabolic cont...

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Bibliographic Details
Published in:Hemodialysis international 2013-10, Vol.17 (4), p.639-643
Main Authors: Cornelis, Tom, Spaanderman, Marc, Beerenhout, Charles, Perschel, Frank H., Verlohren, Stefan, Schalkwijk, Casper G., Sande, Frank M., Kooman, Jeroen P., Hladunewich, Michelle
Format: Article
Language:English
Subjects:
Adult
Angiogenesis Inhibitors - blood
antiangiogenic factors
Female
Glomerulonephritis, IGA - blood
Glomerulonephritis, IGA - therapy
Hemodynamics
Humans
Infant, Newborn
Intensive hemodialysis
Male
Pregnancy
Pregnancy Complications - blood
Pregnancy Complications - therapy
Pregnancy Outcome
Renal Dialysis - adverse effects
Renal Dialysis - methods
Young Adult
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Summary:We report on a 21‐year‐old pregnant patient with IgA nephropathy who was initiated on intensive hemodialysis (8 hours of hemodialysis 3 times a week) at a gestational age of 26 weeks on the basis of worsening kidney function resulting in rapidly progressive fatigue and difficulties in metabolic control. Throughout the pregnancy, and while on intensive hemodialysis, 24‐hour ambulatory blood pressure control was within the target, and results of weekly 24‐hour measurement of central hemodynamics and pulse wave velocity, and of serial levels of circulating (anti‐)angiogenic factors were comparable to normal pregnancies. Estimated fetal growth evolved along the 50th percentile, and no polyhydramnios was detected. After induction for a sudden, unexplained increase in blood pressure, she delivered a healthy boy of 2480 g at a gestational age of 36 weeks. This case adds to the expanding literature that supports the use of intensive hemodialysis in pregnant patients with end‐stage renal disease and illustrates, for the first time, the potential use of serial (anti‐) angiogenic factors and 24‐hour measurements of blood pressure and hemodynamic indices in order to facilitate monitoring of these complicated patients.
ISSN:1492-7535
1542-4758
DOI:10.1111/hdi.12042