Chronic nephritis during pregnancy

　　The exact etiology of this disease has not been confirmed, and it is generally speculated to be related to infection, especially viral infection. There are also reports that some patients had a history of contact with gasoline, hydrocarbons (hydrocarbons) before the onset of the disease, so it is believed that these chemical substances and/or viruses may be pathogenic factors.

　　For patients with high or moderate to severe renal insufficiency, the incidence of pregnancy complications increases from 40% to 80%, and the incidence of preterm birth increases from 57% to 100%. The main complications of this disease are severe hypertensive pregnancy, fetal growth restriction, and anemia, which should attract the high attention of clinical doctors and patients.

　　The clinical manifestations of this disease can be diverse, ranging from asymptomatic proteinuria or microscopic hematuria to obvious lower limb edema, fatigue, exhaustion, anemia, hypertension, or nephrotic syndrome, even uremia.

　　Clinically, the disease can be classified as follows according to the main manifestations.

　　1、Common type: The onset may be similar to acute nephritis, with obvious edema, hematuria, and hypertension. Afterward, the condition may temporarily relieve or progressively worsen. Most patients have no symptoms at onset, and the disease is discovered only after examination. Most urinary protein is below 3.5g/24h. There are often red blood cells in the urine, even a few casts. Although the blood pressure is elevated, it is not the main manifestation.

　　2、Hypertensive type: Proteinuria can be slight, accompanied by hypertension. Blood pressure often remains high.

　　3、Nephrotic type: The pathological changes of this disease are mainly membrane proliferation type. Patients have significant proteinuria, casts, and edema. The daily excretion of urinary protein is more than 3-3.5g. Plasma protein decreases, albumin and globulin ratio is inverted, and cholesterol increases.

　　To prevent the onset of chronic nephritis and protect kidney function, there must be mutual cooperation between doctors and patients. Patients should pay attention to the condition of the kidneys at all stages of life. Strictly follow the guidance of the specialized doctor to select and take medication. Pregnant women should develop good living habits, avoid overwork, and fatigue. Daily exercise should be moderate to enhance their ability to resist diseases, and they should avoid long-distance travel and excessive immersion in work. Patients with damaged kidney function should avoid using nephrotoxic drugs. In terms of diet, they should choose food according to the doctor's requirements and avoid blind tonification.

　　The main examination methods for pregnancy complicated by chronic nephritis are as follows.

　　1、Blood pressure examination: Blood pressure examination is one of the common examination items for this disease.

　　2、Urine routine examination: Patients often have persistent proteinuria before pregnancy or before 20 weeks of pregnancy and discover this disease. Depending on the severity of the lesion, the urine may contain an unequal amount of red and white blood cell casts.

　　3、Renal function testing: In the early stage of the disease, the function of the kidneys is less affected, and by the late stage, various kidney functions have varying degrees of decline.

　　4、Blood routine: Due to the large loss of protein and the damage to the renal parenchyma in chronic nephritis, the production of erythropoietin in the kidneys is reduced, so patients often have anemia, which belongs to normal hemoglobin and red blood cell type anemia.

　　5、Fundus examination: The examination may show hemorrhage, exudation, and characteristic peritonealitis consistent with nephritis. In mild chronic nephritis, fundus examination can be normal.

　　6、Abdominal ultrasonography: In the late stage of the disease, there may be symmetrical atrophy of both kidneys and thinning of the cortex.

　　Due to the acute onset and severe symptoms, many pregnant women experience a decrease in appetite, even severe vomiting. During this period, it is required to eat liquid or semi-liquid foods such as juice, milk, lotus root starch, rice flour, etc., 6-8 meals a day to ensure sufficient energy. After the fever slightly subsides, gradually provide high-quality protein foods such as fish flake, minced meat, liver paste, tofu, etc., in combination with easily digestible foods such as soft noodles, rice porridge, noodles, and congee. To reduce the burden on the kidneys, the total intake of protein and salt should be limited, with the protein intake per kilogram of body weight less than 0.8g per day, and the total salt intake should be less than 5g per day. Eating alkaline foods such as fruits, cucumbers, radishes, and milk also helps patients recover. After complete recovery, it is necessary to restore the diet during pregnancy as soon as possible and supplement the insufficient protein intake to ensure the normal development of the fetus.

　　Currently, there is no effective treatment for chronic nephritis, and the entire pregnancy should be closely monitored for both the mother and the fetus. Whether to continue the pregnancy should be decided according to the condition of the mother and the fetus, and the timing and mode of delivery should be comprehensively decided according to the blood pressure, urine protein, renal function, gestational age, placental function, and fetal condition of the mother.

　　1. Generally, after treatment, the pregnancy can be maintained until 36 weeks, and termination of pregnancy can be considered according to the condition. At this time, the fetus is mature, and delivery can help the fetus leave an unfavorable environment early, and can also avoid exacerbating the kidney damage of the pregnant woman.

　　2. When complicated with gestational hypertension syndrome or difficult to control blood pressure, or renal function decline, even if the fetus is small, it should be considered to promote fetal lung maturation through medication to terminate the pregnancy in time. After the third trimester, the baby has the possibility of survival, and if there is a serious reduction in placental function at this time, cesarean section should be performed in time to avoid intrauterine fetal death.

　　3. When chronic nephritis is complicated with pregnancy, the opportunity for placental dysfunction increases, and it is necessary to terminate the pregnancy in advance, and the cervix is often not mature, and the fetus has poor tolerance to hypoxia, so cesarean section should be considered. Newborns are generally weak and usually require special care.

　　4. It is important to protect kidney function during pregnancy. The intake of high-quality protein during pregnancy is beneficial for the growth and development of the fetus and does not increase the burden on the kidneys. After giving birth, the function of the kidneys decreases, and appropriate fluid expansion should be done to protect the kidneys.