Glomerulonephritis and pregnancy: causes, diagnosis

Pregnancy in some cases is complicated by the appearance of various complications from the mother and fetus. This is not accidental, since immunity is "turned off" during pregnancy, creating conditions for the emergence of various pathologies. Glomerulonephritis in pregnant women occurs in only 0.1% of all cases.

Why does glomerulonephritis occur during pregnancy?

The most common cause of glomerulonephritis in pregnancy is beta-hemolytic streptococcus, which is the causative agent of chronic foci of infection. This microbe can cause diseases such as tonsillitis, pyoderma, tonsillitis, scarlet fever, erysipelas. In some cases, the causative agent of the disease can become Staphylococcus aureus, pneumococcus, meningococcus, as well as viruses and fungi.

In any case, foci of infection that were not sanitized before conception may lead to an association such as glomerulonephritis and pregnancy. In addition to pathogens, there are predisposing factors that can provoke the appearance of kidney diseases.

One of them, as already mentioned, is reduced immunity, but it can also be factors such as severe hypothermia or poisoning with chemicals. Pregnant women develop less glomerular filtration on average by 40%, which, with the passage of time and the development of the child, only worsens. This leads to a violation of salt metabolism and water retention in the body. That's why pregnant women even without kidney diseases swell, especially towards the end of gestation.

Reducing the filtration of the glomeruli of the kidneys leads to accumulation in the body of poisons, acids, salts, toxic residues and metabolic products. Consequently, in the urine of pregnant women first appear traces, and then a certain amount of protein. Violation of filtration can cause the appearance of blood in the urine and increase blood pressure.

Symptoms and signs of a disease

By the nature of the course of the disease can be acute and chronic. Acute glomerulonephritis occurs very rarely, and mostly pregnant women suffer from a chronic form. All women with this disease are at high risk because this group of patients has complications such as kidney failure, miscarriage, pulmonary edema, encephalopathy, intrauterine fetal death, and many others.

If such patients develop hypertensive or mixed forms of the disease, then, as a rule, this is an indication for abortion and treatment of the underlying disease.

Usually this group of women is under the supervision of a local obstetrician and nephrologist at the same time. Examination and appropriate treatment should be carried out only in a hospital.

The first hospitalization is shown immediately in 1 trimester, where the status of a woman and the possibility of further development of pregnancy are determined. Repeated hospitalization is shown in terms of 32-26 weeks, when the question of the type of delivery and preparation for childbirth is being decided.

Chronic glomerulonephritis and pregnancy are usually accompanied by symptoms such as hematuria( the presence of blood in the urine), oliguria( decrease in the amount of urine output), hypertension( high blood pressure) and swelling. To diagnose the condition, traditional methods of diagnosis are usually used - general blood and urine tests( in the dynamics of the disease every 2 weeks), ultrasound, blood pressure measurement and weight gain.

Very often, chronic glomerulonephritis is complicated by such diseases as anemia, exacerbation of chronic gastritis, hepatocholecystitis, which requires immediate hospitalization and treatment in the hospital. This is done because during pregnancy the fetus suffers, lags behind in development, oxygen starvation, nutrient deficiency and other pathologies develop.

Differential diagnosis with complications such as toxicosis( gestosis) is necessary, especially in the second half of pregnancy. A distinctive feature in glomerulonephritis is the presence of blood and blood cylinders in the urine, which is not observed with gestosis. It is important to note that the acute process, not cured during and after pregnancy during the year, is considered chronic.

It was noted that glomerulonephritis in pregnant women is often the cause of the appearance of renal pathology in newborns, since this disease can be transmitted in some cases by inheritance.

Treatment of glomerulonephritis and prevention measures

In order to assess the degree of kidney damage, there are several degrees of risk that require therapy and, if necessary, abortion.

• 1 degree of risk, which is considered minimal, and the number of complications does not exceed usually 20%.Therapy during pregnancy is not performed, since there is a latent form of the disease.
• 2 degree of risk, which often causes complications, as there is a pronounced picture of the disease. The degree of complications is from 20 to 50%, and the treatment is carried out only in a hospital.
• 3 degree, which is considered the most severe, since the number of complications exceeds 50%, requires immediate termination of pregnancy and treatment of the underlying disease.

Treatment of the disease during pregnancy is reduced to adherence to the necessary bed rest and diet( table number 7), as well as to the conduct of drug therapy. Treatment with medicines is difficult, because not all drugs can be consumed during pregnancy because of the possible harm to the health of the fetus.

The best measure of glomerulonephritis prophylaxis is the sanation of chronic foci of infection before pregnancy, as well as the necessary course of therapy during the planning period.