A CLINICAL CASE OF PREGNANCY AND CHILDBIRTH OF A DIALYSIS PATIENT FROM A HUSBAND WITH A TRANSPLANTED KIDNEY

Patient M., 28, was diagnosed with a genitourinary tract anomaly, urethral duplication, end-stage renal disease (ESRD) and viral hepatitis C. She had been receiving hemodialysis (HD) since 2015 (for 10 years), not married.

She presented to the Republican Specialized Scientific and Practical Medical Center for Nephrology and Kidney Transplantation (Tashkent, Uzbekistan) on January 26, 2025, having been diagnosed with a nine-week pregnancy.

History: She has suffered from urinary tract infections since age 11. A medical examination revealed ureterohydronephrosis, caused by a duplication of the ureter. Elevated blood creatinine was also found, and CKD was diagnosed. She was followed by a nephrologist until 2015, when she developed ESRD. Due to a ureteral anomaly, she was denied a kidney transplant. She had vascular access (arteriovenous fistula) created and began hemodialysis. She was previously unmarried.

In 2021, she married a 25-year-old patient also suffering from ESRD and received dialysis at the same clinic for four years. Later her husband received a kidney transplant.

In December 2024, after her illness, an ultrasound revealed she was two weeks pregnant. She categorically refused an abortion and was under the supervision of a gynecologist.

During an examination at our center, she had no complaints, her general condition was satisfactory BP 100/60 mmHg, heart rate 90 bpm.

Laboratory tests revealed: hemoglobin-137, erythrocytes-4.4, leukocytes-3.8, ESR-7; urea-22.2, creatinine-699, cholesterol-4.4, albumin-40.9, globulin-25, total protein-84, potassium-5.1, glucose-4.69, P-1.76, Ca-1.7, homocysteine-13.45, ferritin-3000, vitamin B12-955, folate-3.8, d-dimer-0.84, fibrinogen-482-583. Hormones: prolactin 1265, PTH 1469, TSH 1.14, T3 3.37, T4 11.1. Tests for HIV, hepatitis B, C, and TORCH infections were negative.

ECG: sinus tachycardia, heart rate 96. EOS normal, EPS semi-vertical. Metabolic changes in the myocardium. Echocardiography revealed normal overall and regional myocardial contractility, normal cardiac chambers, stage 1 LVH, LVDD, and RVD, dyskinesia of the anterior septal wall of the LV, aortic thickening, and MR2, TR1, and LR.

She had monthly gynecological examinations and fetal screening, and also regularly took: iron supplements, omega-3, vitamin complexes, iodine supplements, amino acid supplements, hepatoprotections, adsorbents, potassium and calcium supplements, and periodically received low-molecular-weight heparins. Ultrasound showed fetal development progress, periodically revealing uterine hypertonicity and reactive liver changes. Monthly prenatal screening revealed fetal development and progression, with relative polyhydramnios detected.

From 12 weeks of pregnancy, she underwent dialysis every other day, and by 20 weeks, she was undergoing daily hemodialysis with a high-flux dialyzer. 

On July 9, 2023, at 32 weeks of pregnancy, she underwent a planned cesarean section, resulting in the birth of a newborn weighing 1940 grams.

The mother and child remained in the maternity hospital for 10 days and received therapy, after which they were transferred to the neonatology department, where they were monitored for an additional 20 days.

At a follow-up examination at our center one month later, the mother's condition was stable and she continues to receive hemodialysis, while the child is growing and developing satisfactorily.