The management challenges of non-preeclampsia-related nephrotic syndrome in pregnancy

Côté, Anne Marie; Sauvé, Nadine

doi:10.1258/om.2011.110001

Cited by 12 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…47,48 Studies have suggested that nondihydropyridine calcium channel blockers such as diltiazem decrease proteinuria and thus diltiazem could be considered for women with hypertension and proteinuria during pregnancy, 49 though there are limited studies of this agent in pregnancy. 50,51…”

Section: Preconceptionmentioning

confidence: 99%

Management of Preexisting Diabetes in Pregnancy

Alexopoulos

Blair

Peters

2019

JAMA

121

View full text Add to dashboard Cite

Importance: The presence of preexisting type 1 or type 2 diabetes in pregnancy increases the risk of adverse maternal and neonatal outcomes, such as preeclampsia, caesarian section, pre-term delivery, macrosomia and congenital defects. Approximately 0.9% of the 4,000,000 births in the United States are complicated by preexisting diabetes. Observations: Women with diabetes have increased risk for adverse maternal and neonatal outcomes and similar risks are present for either type 1 or type 2 diabetes. Both forms of diabetes require similar intensity of diabetes care. Preconception planning is very important to avoid unintended pregnancies, and to minimize risk of congenital defects. Hemoglobin A1c goal at conception is <6.5% and during pregnancy is <6.0%. It is also critical to screen for and optimize comorbid illnesses such as retinopathy and nephropathy. Medications known to be unsafe in pregnancy, such as angiotensin-converting enzyme inhibitors and statins, should be discontinued. Obese women should be screened for obstructive sleep apnea, which is often undiagnosed and can result in poor outcomes. Blood pressure goals must be considered carefully, as lower treatment thresholds may be required for women with nephropathy. During pregnancy, continuous glucose monitor use can improve glycemic control and neonatal outcomes for women with type 1 diabetes. Insulin is first-line therapy for all women with preexisting diabetes; injections and insulin pump therapy are both effective approaches. Rates of severe hypoglycemia are increased during pregnancy; therefore glucagon should be available and close contacts trained in its use. Low-dose aspirin is recommended soon after 12 weeks of gestation to minimize the risk of preeclampsia. The importance of discussing long-acting reversible contraception before and after pregnancy cannot be overstated, to allow for appropriate preconception planning. Conclusions and Relevance: Preexisting diabetes in pregnancy is complex and is associated with significant maternal and neonatal risk, but optimization of glycemic control, medication regimens and careful attention to comorbid conditions can help mitigate these risks, and ensure quality diabetes care before, during and after pregnancy.

show abstract

Section: Preconceptionmentioning

confidence: 99%

Management of Preexisting Diabetes in Pregnancy

Alexopoulos

Blair

Peters

2019

JAMA

121

View full text Add to dashboard Cite

show abstract

“…Saat mendiagnosis sindroma nefrotik, perlu dinilai konsekuensi klinis yang menyertai hipoalbuminemia dan penurunan tekanan onkotik, seperti edema perifer, asites, dan efusi pleura/ perikardial. 4 Wanita dengan sindroma nefrotik biasanya memiliki edema. Akan tetapi, ini adalah tanda yang sangat nonspesifik selama kehamilan karena kemunculannya ditemukan pada dua pertiga kehamilan normal.…”

Section: Pembahasanunclassified

“…Beberapa pasien mungkin akan memerlukan diuretik harian, dengan dosis awal 5-10 mg. Loop diuretic seperti furosemid adalah yang paling sering dipilih sebagai duretik awal. 2,4 Monitoring ketat terhadap berat badan, elektrolit (natrium, kalium, kalsium, dan magnesium) dan bikarbonat (untuk menghindari alkalosis karena diuretik), keseimbangan cairan, dan tekanan darah mungkin diperlukan secara harian hingga TD stabil dan keseimbangan cairan dan elektrolit tercapai dengan diuretik. Serial fetal growth scan penting jika akan menggunakan diuretik pada kehamilan.…”

Section: Pembahasanunclassified

“…Serial fetal growth scan penting jika akan menggunakan diuretik pada kehamilan. 4 Penggunaan albumin intravena untuk memperbaiki tekanan onkotik intravaskular masih menjadi kontroversi, penggunaan albumin intravena untuk hipotensi dan kenaikan kreatinin serum tetapi efeknya selalu bersifat sementara; tidak ada indikasi penggunaan albumin intravena untuk meningkatkan kadar albumin serum. Penggunaan koloid tidak direkomendasikan kecuali dalam kondisi yang luar biasa.…”

Section: Pembahasanunclassified

See 1 more Smart Citation

Manajemen Anestesi pada Pasien Seksio Sesarea Primigravida 35 Minggu dengan Sindroma Nefrotik

Kartapraja

Suwondo

2020

JAOI

View full text Add to dashboard Cite

Sindroma nefrotik adalah sekumpulan gejala berupa proteinuria, hipoalbuminemia, edema, hiperkolesterolemia, dan lipiduria yang ditandai peningkatan permeabilitas dinding kapiler terhadap protein serum. Sindroma nefrotik pada kehamilan jarang terjadi namun bila tidak dikelola dengan baik akan meningkatkan morbiditas. Sindroma anefrotik dapat muncul sebelum umur kehamilan 20 minggu dan sering disebabkan oleh glomerulonephritis, sedangkan yang muncul sesudah umur kehamilan 20 minggu patut diduga disebabkan atau disertai suatu preeklampsia. Dilaporkan pasien 35 minggu dengan diagnosis preeklamsia, sindroma nefrotik dan suspek edema pulmo. Pasien di diagnosis sindroma nefrotik sejak kehamilan 12 minggu dan mendapat terapi metilprednisolone 16 mg 1-0-0 hingga sekarang. Pada usia kehamilan 28 minggu pasien didiagnosis preeklamsia. Datang karena kontraksi yang semakin kencang. Pasien dilakukan seksio sesarea dengan tehnik regional anestesi epidural Levobupivacain 0.5% isobarik 11 ml, janin cukup viable dilahirkan. Pasca operasi pasien dirawat di high care unit dan pulang ke rumah setelah perawatan 8 hari dalam kondisi baik. Manajemen anestesia pada ibu hamil dengan sindroma nefrotik antara lain sering disertai tekanan darah tinggi atau preeklampsia, malnutrisi dan hilangnya zat-zat yang diperlukan tubuh bersamaan dengan hilangnya protein melalui urine. Pasien seharusnya ditangani melalui pendekatan multidisipliner dengan spesialis perinatologi, nefrologi, dan neonatologi, dengan pemahaman terhadap pentingnya menjaga keseimbangan agar sesuai dengan perubahan fisiologis wanita hamil normal akan memberikan prognosis yang baik dalam menurunkan tingkat morbiditas. Anesthesia Management of Caesarean Section in 35 Weeks Primigravida Patients with Nephrotic Syndrome Abstract Nephrotic syndrome is a set of symptoms in the form of proteinuria, hypoalbuminemia, edema, hypercholesterolemia, and lipiduria which are characterized by an increase in capillary wall permeability to serum proteins. Nephrotic syndrome in pregnancy is rare but if not managed properly, it will increase a morbidity. Nephrotic syndrome can occur before 20 weeks of gestation and is often caused by glomerulonephritis, whereas if appears after 20 weeks' gestation is thought to be due to or accompanied by preeclampsia. A 35-week patient was reported with preeclampsia, nephrotic syndrome and suspected pulmonary edema. Patients were diagnosed with nephrotic syndrome since 12 weeks' gestation and were treated with methylprednisolone 16 mg 1-0-0 until now. At 28 weeks' gestation the patient was diagnosed with preeclampsia. she came to hospital due to primature contraction. Patient underwent SC with a 11 ml Levobupivacaine 0.5% drug isobaric epidural anesthesia regional technique, the fetus was viable enough to be born. After surgery the patient was treated at HCU and returned home after 8 days of treatment in good condition. Management of anesthesia in pregnant women with nephrotic syndrome is often accompanied by high blood pressure or preeclampsia, malnutrition and loss of substances needed by the body along with loss of protein through urine. Patients should be treated through a multidisciplinary approach, along with specialists in perinatology, nephrology, and neonatology. With an understanding of the importance of maintaining balance in accordance with the physiological changes of normal pregnant women will provide a good prognosis in reducing morbidity.

show abstract

“…Nephrotic-range proteinuria complicates 0.32% of pregnancies, of which pre-eclampsia contributes to 0.19% 6,7. In women with LN where nephrotic-range proteinuria is a criterion for diagnosis, differentiating new-onset SLE or LN in pregnancy from pre-eclampsia remains a challenge.…”

mentioning

confidence: 99%

Early Onset Pre-Eclampsia with Nephrotic Range Proteinuria as the Initial Manifestation of Lupus Nephritis: Report of three cases

Udupa

Keepanasseril

Vijayan

et al. 2019

Sultan Qaboos Univ Med J

View full text Add to dashboard Cite

Early onset pre-eclampsia (pre-eclampsia at less than 34 gestational weeks) is a severe form of preeclampsia; in addition, some women may also develop nephrotic range proteinuria. De novo diagnosis of lupus nephritis (LN) in pregnancy is challenging as it may present with features similar to commonly occurring preeclampsia. We report three cases of early onset pre-eclampsia with nephrotic range proteinuria and subsequent diagnosis of LN at the Women and Children hospital attached to Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, between 2014 and 2017. These cases highlights the need for further evaluation of the association between nephrotic-range proteinuria and early onset pre-eclampsia. The index of suspicion for underlying LN of these type of cases should be high. Earlier detection of LN will prompt better management that can avert or delay short- and long-term morbidity. Keywords: Lupus Nephritis; Pre-Eclampsia; Nephrotic Syndrome; Proteinuria; Case Reports; India.

show abstract

The management challenges of non-preeclampsia-related nephrotic syndrome in pregnancy

Cited by 12 publications

References 22 publications

Management of Preexisting Diabetes in Pregnancy

Management of Preexisting Diabetes in Pregnancy

Manajemen Anestesi pada Pasien Seksio Sesarea Primigravida 35 Minggu dengan Sindroma Nefrotik

Early Onset Pre-Eclampsia with Nephrotic Range Proteinuria as the Initial Manifestation of Lupus Nephritis: Report of three cases

Contact Info

Product

Resources

About