Pregnancy complicated with nephrotic syndrome

　　Proliferative or membranous proliferative glomerulonephritis, lipoid nephrosis, lupus nephritis, familial nephritis, diabetic nephropathy, syphilis, amyloidosis, renal vein thrombosis, heavy metal or drug poisoning, and allergy can all cause this syndrome. The most common cause of nephrotic syndrome occurring in the late pregnancy period is severe pregnancy-induced hypertension.

　　If pregnancy complicated with nephrotic syndrome is not treated in a timely manner, it may lead to the following complications:

　　1. Infection

　　Before the discovery of antibiotics, patients with this syndrome mainly died of infection. Common sites of infection include the respiratory tract, urinary tract, skin, and primary peritonitis.

　　2. Thrombosis

　　Thrombotic complications are related to blood concentration, hypercoagulable state, deficiency of anticoagulant factors, and disorders of the fibrinolytic mechanism, with an incidence rate of 10% to 50%. Most cases are renal vein thrombosis, followed by lower limb venous thrombosis, and even coronary vascular thrombosis. It can be accompanied by fatal pulmonary embolism.

　　3. Malnutrition

　　In addition to atrophy caused by protein malnutrition and growth and development disorders in children, there are also manifestations of malnutrition in many aspects, such as vitamin D deficiency, calcium and phosphorus metabolic disorders, secondary hyperparathyroidism, microcytic (iron deficiency) anemia, zinc deficiency leading to fatigue, slow wound healing, and copper deficiency.

　　4. Renal function damage

　　Patients may experience a decrease in renal blood flow due to severe hypovolemia, leading to transient pre-renal azotemia. Recovery occurs after treatment with fluid expansion and diuresis.

　   Edema associated with pregnancy and nephrotic syndrome initially often appears at the ankles, presenting as a concave type, and then extends to the whole body. The face is particularly puffy upon waking in the morning. Edema is often accompanied by fatigue, dizziness, loss of appetite, nausea, and vomiting.

　　To reduce the incidence of pregnancy complicated with nephrotic syndrome, keep the living environment fresh, avoid crowded places, keep the skin clean, prevent skin injury, prevent infection, and seek timely medical treatment for infections. Eat easily digestible and light food. Pay attention to the combination of work and rest, enhance the body's immunity, exercise regularly, and regularly review routine urine tests and kidney function.

　　Inquire about the medical history in detail to determine the cause of the disease, and confirm the diagnosis through the following examinations:

　　1. Urinalysis

　　During urine tests, the 24-hour urine protein excretion of patients is greater than 3g/d, with higher levels reaching 5g/d or more. When combined with other kidney diseases, red and white blood cells and (or) cellular casts may appear in the urine, as well as systemic edema.

　　2. Biochemical Determination

　　Biochemical tests may show cholesterol levels greater than 300mg% or more, increased blood lipid levels, decreased albumin levels, reversed albumin-globulin ratio, varying degrees of increased blood urea nitrogen and creatinine, etc.

　　3. Others

　　Laboratory tests for other related diseases may show increased blood sugar levels, positive syphilis serological reactions, positive autoantibodies or antinuclear antibodies, etc.

　　Patients with pregnancy complicated with nephrotic syndrome should also pay attention to a light diet, try to avoid spicy and刺激性 foods, and pay attention to a balanced diet. Follow the doctor's advice for diet if necessary.

　　Patients with severe nephrotic syndrome accompanied by renal insufficiency are not suitable for pregnancy. If they are already pregnant, they should adopt the following treatment methods:

　　1. General Treatment

　　Patients should pay attention to their diet, correct hypoproteinemia, and appropriately use diuretics to improve the general condition of the patient.

　　2. Regular Checks

　　Regularly check urine protein, plasma protein, cholesterol, and kidney function. If the condition worsens, consider terminating the pregnancy.

　　3. After 32 weeks of pregnancy

　　After 32 weeks of pregnancy, regular checks of fetal placental function should be carried out, and active prevention and treatment of pregnancy-induced hypertension should be implemented. If the pregnancy reaches 36 weeks after treatment, consider terminating the pregnancy.