Chronic glomerulonephritis complicating pregnancy

　　The definite etiology of chronic glomerulonephritis complicating pregnancy has not been confirmed, but it is generally believed to be related to infection, especially viral infection. There are also reports that patients had a history of exposure to gasoline, hydrocarbons (hydrocarbons) before the disease. Therefore, it is considered that these chemical substances and/or viruses may be pathogenic factors.

　　Patients with chronic glomerulonephritis complicating pregnancy, if they have hypertension or moderate to severe renal insufficiency, the incidence of pregnancy complications increases from 40% to 80%, mainly including severe preeclampsia, fetal growth restriction, anemia, and so on, the rate of preterm birth increases from 57% to 100%, and the perinatal mortality rate is all 100%. This disease may also lead to infection in patients.

　　This disease is more common in adults, and is less common in the elderly and children. Tuberculous cases are more common in males than in females, and autoimmune-induced 'idiopathic' cases are more common in females than in males. The onset is gradual, and the early symptoms include fatigue, weakness, malaise, decreased appetite, significant weight loss, which resembles neurosis. The typical clinical manifestations include the following points:

　　24. Hyperpigmentation

　　Hyperpigmentation is seen in primary patients, due to increased secretion of adrenocorticotropic hormone (ACTH) by the pituitary gland, melanocyte-stimulating hormone also increases, resulting in hyperpigmentation of the skin and mucous membranes, which is particularly obvious in areas of friction, palm prints, areola, scars, etc. Patients with secondary hypopituitarism due to pituitary anterior lobe dysfunction do not have this symptom.

　　22. Cardiovascular system

　　The blood pressure of nearly half of the patients can be below 90/60mmHg (12/8kPa), and in emergencies, it can drop to zero, with symptoms such as dizziness, orthostatic hypotension, and syncope.

　　20. Gastrointestinal system

　　Patients may have symptoms such as decreased appetite, a preference for salty food, weight loss, nausea, vomiting, abdominal distension, poor digestion, diarrhea, abdominal pain, constipation, and so on.

　　18. Nervous and nervous aspects

　　Muscle weakness in this aspect is one of the main symptoms, and other symptoms may include apathy, fatigue, drowsiness, mental disorder, lack of concentration, decreased memory, irritability, insomnia, and so on.

　　16. Other

　　Other common symptoms include hyperkalemia, hyponatremia, chronic dehydration, etc. The body weight is usually reduced by 5-10kg or more, gluconeogenesis is weakened, and symptoms such as hypoglycemia on an empty stomach, decreased sexual function in both genders, impotence in males, loss of pubic hair in females, menstrual disorders or amenorrhea may occur. Mild patients can become pregnant, and if the cause is tuberculosis infection, symptoms such as low fever and night sweats are often present.

　　To reduce the incidence of pregnancy complicated with chronic glomerulonephritis, the following preventive measures can be taken:

　　11. Avoid factors that can worsen the condition, such as infection and fatigue.

　　10. Strictly control diet and ensure adequate nutrition.

　　9. Actively control and treat complications.

　　8. Use or avoid drugs with nephrotoxicity and those that are prone to induce kidney injury.

　　7. Use traditional Chinese medicine for treatment, based on the patient's condition, syndrome differentiation, formulating medicine, and using traditional Chinese medical methods to improve and delay the progression of renal failure.

　　6. Conduct relevant kidney examinations during pregnancy.

　　Pregnancy complicated with chronic glomerulonephritis refers to chronic glomerulonephritis occurring during pregnancy. This disease can be diagnosed by the following examinations:

　　1. Laboratory examination

　　1. Urinalysis: This disease is often discovered before pregnancy or before 20 weeks of gestation due to persistent proteinuria, with the nephrotic type patients having the most proteinuria. In the late stage of chronic glomerulonephritis, most glomeruli are damaged, and the leakage of protein decreases gradually, so less proteinuria does not necessarily indicate an improvement in the disease, and it cannot be used as a standard for induced labor. Healthy kidneys should be able to concentrate urine to a specific gravity of 1.020 or above, while in the late stage of chronic glomerulonephritis, due to decreased concentration and dilution ability, the urine specific gravity is often fixed at around 1.010. There may be varying amounts of red and white blood cell casts in the urine.

　　2. Blood routine: Chronic glomerulonephritis, due to the large loss of protein and the damage to the renal parenchyma, leads to a decrease in renal erythropoietin, so it often accompanies anemia, which belongs to normal hemoglobin and red blood cell anemia. It is difficult to treat anemia in patients with chronic renal insufficiency, and it is advisable to transfuse blood in small amounts and multiple times.

　　3. Renal function tests: In the early stage of the disease, renal function is less affected, but in the late stage, renal function has varying degrees of decline.

　　Second, other auxiliary examinations

　　1. Fundus examination: fundus examination can show hemorrhage, exudation, and typical retinitis that is consistent with glomerulonephritis. In mild chronic glomerulonephritis, fundus examination can be normal.

　　2. Renal biopsy: Renal biopsy can be performed during pregnancy, which is very helpful for clarifying the diagnosis and understanding the extent of the lesion.

　　There are no special dietary requirements for patients, and normal diet is generally sufficient. Pay attention to a rich and balanced diet. Ensure the body's needs for heat, protein, vitamins, and other nutrients required for normal metabolism. Appropriately increase the intake of vegetables and fruits.

　　If there is hypertension and proteinuria before pregnancy, or blood pressure is above 150/100mmHg (20/13.3kPa) or there is azotemia, it is not advisable to become pregnant. Once pregnant, an early abortion should be performed as pregnancy will increase the burden on the kidneys and is prone to complications such as hypertension during pregnancy, which is very harmful to both the mother and the child.

　　During pregnancy, it is important to ensure sufficient sleep and rest, avoid fatigue, catching a cold, infection, and other factors, and enhance the body's ability to resist diseases. Actively prevent and treat hypertension during pregnancy, and hypertensive patients should reduce sodium intake. Weekly urine routine, serum creatinine, urea nitrogen, and uric acid should be measured. If renal function further deteriorates, or blood pressure rises above 150/100mmHg (20/13.3kPa) and is difficult to control, consider terminating the pregnancy. The serum creatinine level of 141.4μmol/L can be used as an indicator for terminating the pregnancy.

　　Sudden increase in blood pressure often occurs around 36 weeks, which may lead to fetal death and deterioration of renal function, and it may be necessary to terminate the pregnancy. Those who need to terminate the pregnancy before 36 weeks can use dexamethasone to promote fetal lung maturation.