Nephrotic syndrome during pregnancy

　　Proliferative or membranous proliferative glomerulonephritis, lipoid nephropathy, lupus nephritis, familial nephritis, diabetic nephropathy, syphilis, amyloidosis, renal venous thrombosis, heavy metal or drug poisoning, and allergy can all cause this syndrome. The most common cause of nephrotic syndrome occurring in the late stages of pregnancy is severe hypertensive disease during pregnancy.

      Initially, it is most common in the ankles, presenting as a sunken appearance, and then extends to the whole body. The face is obviously edematous upon waking up in the morning. Edema is often accompanied by fatigue, dizziness, loss of appetite, nausea, and vomiting. The most common complication of nephrotic syndrome during pregnancy is hypertension. Due to the presence of disease in the kidneys, it may cause difficulties in urination, proteinuria, and other diseases.

　　1. Edema

　　Initially, it is most common in the ankles, presenting as a sunken appearance, and then extends to the whole body. The face is obviously edematous upon waking up in the morning. Edema is often accompanied by fatigue, dizziness, loss of appetite, nausea, and vomiting.

　　2. Cardiovascular symptoms

　　Patients have low blood pressure and a small pulse pressure, which is prone to fainting. When antihypertensive and diuretic drugs are used inappropriately, marked hypotension, even circulatory failure or shock, may occur.

　　1. The impact of nephrotic syndrome on mother and child

      The main impact of pregnancy is the increased incidence of concurrent hypertensive diseases during pregnancy, fetal growth restriction, preterm birth, intrauterine fetal death, or low birth weight infants. The extent of the impact depends on the pathogenic cause and the degree of renal insufficiency. Patients with mild renal insufficiency and without hypertension have a low chance of developing complications during pregnancy; if the pathogenic factors can be eliminated (such as syphilis or drug-induced), the prognosis is usually good.

　　2. The impact of pregnancy on nephrotic syndrome

      Pregnancy has no adverse effects on patients with mild renal insufficiency, except for some cases of collagen. Due to increased renal blood flow during pregnancy, increased renal venous pressure can lead to exacerbation of the condition, increased excretion of urinary protein; in addition, blood concentration and slow blood flow increase the chance of thrombosis. Once renal venous thrombosis occurs, it will further worsen renal function. Long-term follow-up has found that at least 20% of patients will develop end-stage renal failure and need dialysis or kidney transplantation.

　　43. Urinalysis

　　24h urine protein quantification > 3g/d, with higher levels up to 5g/d or more, with other kidney diseases, red and white blood cells and/or cellular and granular casts appear in the urine, and general edema.

　　41. Biochemical determination of cholesterol (>300mg% above)

　　and increased blood lipid levels; albumin levels decreased, albumin-globulin ratio inverted; blood urea nitrogen and creatinine may increase to varying degrees, hypoproteinemia, plasma total protein less than 5g%, albumin less than 3g%.

　　38. Other

　　Laboratory findings of related diseases include increased blood glucose levels, positive syphilis serological reaction, positive autoantibodies or antinuclear antibodies, etc.

　　36. Lipiduria.

     In addition to routine treatment, patients with pregnancy complicated by kidney disease should also pay attention to a light diet, try to stay away from spicy and刺激性 food, and at the same time pay attention to a balanced diet, ensure nutrition, and promote faster recovery from the disease.

　　Firstly, severe pre-pregnancy

　　Patients with nephrotic syndrome and renal insufficiency are not suitable for pregnancy and should adopt contraceptive measures.

　　Secondly, during pregnancy

　　General Treatment

　　26. Quality protein. When azotemia is present, the intake of protein must be appropriately restricted;

　　Correct hypoproteinemia: intermittent intravenous infusion of plasma or human serum albumin;

　　Appropriate use of diuretics can control edema and improve the general condition of the patient.

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

　　22. After 32 weeks of pregnancy, regular examinations of fetal placental function, B-ultrasound biophysical scoring, Doppler umbilical artery, renal artery, and middle cerebral artery examination should be carried out to actively prevent and treat pregnancy-induced hypertension. If treatment is received, consideration should be given to terminating pregnancy at 36 weeks of gestation.