Pregnancy complicated with acute glomerulonephritis

　　The causes of pregnancy complicated with acute glomerulonephritis are the same as those for non-pregnant individuals. The onset of acute nephritis is mostly due to an immune response caused by streptococcal infection. In terms of pathogenesis, it belongs to an immune complex-type nephritis. Some patients are caused by other bacterial infections (such as infections caused by Streptococcus pneumoniae, Staphylococcus aureus, meningococcus, etc.) or viral infections (such as mumps virus, measles virus, etc.).

　　If pregnant women with acute glomerulonephritis do not receive timely treatment, it may lead to the following complications:

　　1. Heart failure

　　Heart failure often occurs within the first 1 to 2 weeks after the onset of acute glomerulonephritis. The onset can be either gradual or acute, with varying degrees of severity. In a few severe cases, acute pulmonary edema can suddenly occur, while other manifestations of acute glomerulonephritis may be completely masked.

　　2. Hypertensive encephalopathy

　　Hypertensive encephalopathy refers to a syndrome characterized by neurological symptoms such as headache, vomiting, convulsions, and coma, which occurs when blood pressure rises sharply. The pathogenesis is generally believed to be due to the disorder of autoregulation of intracranial resistance arteries on the basis of systemic hypertension, leading to hypoxia and varying degrees of cerebral edema.

　　3. Acute renal failure

　　In severe cases, blood urea nitrogen may rise by 3.6 mmol/L per day, and blood creatinine may increase by 44.2 μmol/L per day, with blood creatinine levels possibly exceeding 309.4 μmol/L, and acute renal failure may occur.

　　Pregnancy complicated with acute glomerulonephritis is more common in early pregnancy and young pregnant women, often appearing within 10 to 20 days after tonsillitis, sinusitis, scarlet fever, and boils, with symptoms such as hypertension, edema, and hematuria. Patients may complain of fatigue, headache, nausea, and vomiting, and may further develop acute pulmonary edema, acute renal failure, or hypertensive encephalopathy.

　　To reduce the occurrence of pregnancy complicated with acute glomerulonephritis, everyone should pay attention to strengthen their physical fitness, improve their body's defense function, maintain a clean living environment, and reduce upper respiratory tract infections, tonsillitis, and pharyngitis, among other diseases. Attention should be paid to cleanliness to reduce the occurrence of pyoderma. In case of the above diseases, active treatment should be sought, and measures such as clearing chronic infection foci such as recurrent tonsillitis and sinusitis should be taken. During epidemic streptococcal infections, antibiotics can be used for prevention to reduce the incidence. In recent years, the incidence of acute glomerulonephritis has decreased compared to the past.

　　Pregnant women with acute glomerulonephritis can generally be diagnosed by the following examinations:

　　1. Urine

　　Urine specific gravity is increased, usually between 1.022 and 1.032. During edema, urine output may be reduced to 400-700ml, and in a few cases, it may be less than 300ml. During the recovery period, urine output can reach 2000ml. The urine sediment contains many red blood cells, transparent granules, or red blood cell casts.

　　2. Fundus Examination

　　Most patients have normal fundus, a few may appear spasm of small arteries and mild papilledema, which are closely related to increased blood pressure. If there are manifestations such as hemorrhage and exudation, it is likely to be an acute exacerbation of chronic glomerulonephritis.

　　There are no special dietary requirements for pregnant women with acute glomerulonephritis. Generally, normal diet is sufficient. Attention should be paid to a rich and balanced diet, ensuring the body's normal metabolic needs for calories, proteins, and vitamins. Appropriate increase in the intake of vegetables and fruits. In terms of health care, attention should be paid to relaxing the mind, building confidence, maintaining a good mental state, and actively cooperating with the doctor's treatment.

　　The treatment for pregnant women with acute glomerulonephritis is the same as that during non-pregnancy. Most mild cases can recover spontaneously and do not need excessive medication, but the following measures should be taken:

　　1. Rest: Pregnant women with acute glomerulonephritis should rest in bed completely. They should avoid cold and dampness to prevent cold from causing spasm of renal arterioles and increasing the burden on the kidneys.

　　2. Diet Control: Low-salt, low-protein diet. The daily intake should be limited to less than 1000ml. The daily protein intake for adults should be 30-40g to avoid increasing the burden on the kidneys.

　　3. Infection Control: Inject procaine penicillin for muscle, 800,000 units per day, for 10-14 days.

　　4. Symptomatic Treatment: Diuretics should be given to patients with edema and oliguria; antihypertensive drugs such as hydralazine should be given to patients with hypertension and hypertensive encephalopathy; the main treatment for acute heart failure is to reduce the blood volume in circulation, intravenous injection of furosemide; if pulmonary edema is obvious, sedatives and morphine can be injected; in case of renal failure, treatment should be given according to renal failure.

　　5. Obstetric Management: It should be determined according to the situation. Mild cases can continue pregnancy, but if kidney lesions continue to develop and the course lasts for more than 2 weeks, pregnancy should be terminated.