Chronic Kidney Disease in Pregnancy
The case of a pregnant woman with chronic kidney disease. It covers her medical history, presenting complaint of abdominal pain, and past obstetrical history.
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CLINICOPATHALOGICAL CONFERENCE OF GYNAE UNIT 1 CHRONIC KIDNEY DISEASE IN PREGNANCY Presented by: Maniha Sanawar Roll no 178 Abdullah Arshad Roll no 177
HISTORY BIODATA: Pt. Mrs. Salma W/o Mr. Latif 40 Years old Married for 22 years Housewife, not formally educated Resident of Ghotki. Presented in OPD of Sheikh Zayed Hospital on 31stJuly, 2023 She is G5 P4 A 0 LCB 14 years back She is unsure about her dates
Presenting Complain Complain of pain in Abdomen for 3 days
History of Presenting illness She conceived spontaneously in her irregular menstrual cycle while the couple was not practicing any method of contraception. She did not confirm her pregnancy by Scan or UPT and did not have her booking visits anywhere. Her BP was not checked and her Blood Investigations were never carried out. No history of Folic Acid intake, Morning Sickness, Fever, Flu Rash, Pain in Abdomen, PV discharge or PV bleeding. She did not feel Quickening and did not take Hematanics. She had palpitations, SOB on exertion, Loss of Concentration and Generalized Body Weakness for last 4 months. These symptoms were not associated with Heat or Cold Intolerance, Chest Pain, Cough, Fever. There is no history of PICA intake, Perianal Itching or Bleeding from any body orifice. She did not consult any doctor for these symptoms.
Pt. was in usual state of health when she complain of Generalized Pain in Abdomen which was Sudden in onset, Moderate in intensity associated with 2-3 episodes of Vomiting but not associated with Fever, Loose Motion or any Urinary Symptoms. She consulted some doctor at periphery who referred her to tertiary care hospital. She came in the emergency of Sheikh Zayed Hospital where she received some IV medications, her USG Abdomen and Pelvic was done and certain Blood Test were carried out. She was incidentally diagnosed on USG with pregnancy of 19 weeks and Renal Parenchymal changes were detected. Her renal parameters were markedly deranged. She was counseled about the diagnosis of having pregnancy with chronic kidney disease and offered termination of pregnancy after nephrologist opinion in maternal benefit Patient was shifted from medical unit1 to Gynae Unit 1 for termination of pregnancy
PAST OBSTERITICAL HISTORY First pregnancy was 20 years back, Spontaneous, Unsupervised, delivered term baby girl, vaginally at home with no postpartum complications. Baby died at 6thPND without any known cause, pediatric evaluation or hospitalization. Second pregnancy was 19 years back, Spontaneous and Unsupervised, delivered term baby boy vaginally at home with no postpartum complications. Baby died at 6thPND without any known cause, pediatric evaluation or hospitalization. Her 3rdpregnancy was 17 years back, Spontaneous, Unsupervised, delivered term baby boy vaginally at home with no postpartum complications. The child is alive and healthy now. Her 4thpregnancy was 14 years back, Spontaneous, Unsupervised , delivered term baby boy vaginally at home with no postpartum complications. The child is alive and healthy now. There was no history of Hypertension or PPH in previous pregnancies.
GYNEACOLOGICAL HISTORY She achieved menarche at the age of 12 years. Her cycle was regular previously 5/30 days. But for the last 10 years she used to bleed after every 5-8 months with scanty flow Couple never practiced any method of contraception Her PAP Smear was never taken
PAST MEDICAL HISTORY: No history of Diabetes, Hypertension, Asthma, TB PAST SURGIGAL HISTORY Not Significant Drug History : No history of hakim medication, NSAIDS use or Drug Allergy SOCIOECONOMIC HISTORY: She lives in her own house with 4 family members. Her husband is labourer earning 1 thousand per day
EXAMINATION Middle age female of average built and height lying comfortably on bed, well oriented with time, place and person with following vitals BP: 120/ 80 mm hg Pulse: 91 bpm Temperature : 98 * F R/R : 16 She is markedly pale with Koilonychia, no Clubbing, Cyanosis, JVP not raised, Thyroid not enlarged, no Pedal Edema and accessible lymph nodes not palpable
Breast examination: Bilateral breasts were Symmetrical, No mass palpable in all four quadrants CVS: Apex Beat in 5thIntercostal Space S1+S2+ 0 RESPIRATORY: NVB+0 CNS: GCS 15/15, Planters down going
ABDOMEN EXAMINATION INSPECTION: No Striae Scars Marks Visible Pulsations seen PALPATION: Soft non-tender Fundal Height of 16 weeks No Visceromegaly Auscultation: Bowel sounds audible
INVESTIGATIONS BLOOD GROUP: B+ CBC: HB: 6.4 g/ dl TLC: 7.42* 10*9 / L MCH: 29.6pg MCV: 81fl MCHC: 36.6 g/d
BSR 120 mg/dl HBs Ag Negative Anti HCV Negative Anti HIV Negative
LFTS AND RFTS BUN: 38 mg/dl Serum Creatinine: 5mg /dl Bilirubin 0.4 mg/dl SGPT/ALT: 31 U/L SGOT/AST: 32 U/L Serum Alkaline Phosphatase: 184 U/L Serum Albumin: 3.0 g/dl
USG KUB Bilateral small size kidneys Grade 3 parenchymal changes with poor Cortico-Medullary differentiation.
ULTRASOUND REPORT NO. of fetus: Single Lie: Longitudinal Presentation: Cephalic Fetal heart rate: Present Fetal movement: Present Liquor: Scanty AFI : 1-2 B.P.D: 3.8 cm Gestational Age: 18 +1 Placenta: Fundal Placenta Praevia: Absent
PROVISIONAL DIAGNOSIS Chronic kidney Disease(CKD) with Anemia in pregnancy
