Symptoms and treatment of nephropathy in pregnant women. Nephropathy of pregnant women as one of the forms of gestosis in late stages Nephropathy of pregnant women obstetrics

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Nephropathy of pregnancy is one of the most serious complications preeclampsia arising on later dates gestation. The development of nephropathy in pregnant women can cause premature birth and other serious complications.

The exact causes of nephropathy and gestosis are still not known. It is assumed that impairment of the mechanisms of adaptation to pregnancy plays a role in the development of this pathology. Failure occurs at the earliest stages of the formation of the embryo, at the time of implantation of the ovum into the wall of the uterus. The mechanisms of this process remain practically unexplored at the moment.

As a result of all the processes occurring, the normal development of the uterine arteries is disrupted. During pregnancy, such vessels cannot cope with their immediate task - to provide oxygen and nutrients to the baby. Arterial spasm occurs, fetal hypoxia develops. A number of pathological processes are launched that interfere with normal flow pregnancy.

The severe course of gestosis is almost always accompanied by impaired renal function and the development of nephropathy. With this pathology, small-point hemorrhages occur in the parenchyma, capsule and pelvic-cup system. The resulting changes interfere with the normal functioning of the kidneys, which leads to the development of the main symptoms of the disease.

Risk factors for developing nephropathy:

metabolic disorders (obesity, diabetes and others);
kidney pathology;
hypertonic disease;
heart disease;
anemia.

Signs of nephropathy

There are several stages of the disease:

Preclinical stage... The development of nephropathy is preceded by the preclinical stage of the disease. This condition occurs as early as 14-16 weeks of pregnancy and is characterized by minimal changes in blood and urine tests. No other symptoms were observed in the preclinical stage. A pregnant woman feels well and does not even know about the changes that have begun in her body.
Edema... Nephropathy usually develops after 20 weeks of pregnancy. The disease begins with the appearance of edema - the very early symptom gestosis. Swelling during pregnancy is mainly associated with fluid retention and impaired water-salt metabolism. The cause of edema is also considered to be an increase in the permeability of the vascular wall and hormonal changes in the body of the expectant mother.

In the initial stages of the disease, it is quite difficult to recognize edema. Two signs will help detect fluid accumulation:

weight gain of more than 300 g per week;
“Ring symptom” (a pregnant woman takes off all rings, as jewelry becomes too small for her).

In the future, visible swelling appears on the ankles and legs. In severe cases, the swelling spreads to the thighs, abdomen, and the entire surface of the body. Some women have face swelling. Swelling is most pronounced in the evening. During the night, the liquid is evenly distributed throughout the body, and by the morning the puffiness subsides somewhat.

At the moment, not all edema is considered a manifestation of preeclampsia. Many experts consider edema normal occurrence during pregnancy, which does not require special treatment. Edema, not accompanied by an increase in blood pressure and changes in the kidneys, does not pose a danger to the expectant mother.

Hypertension... An increase in blood pressure (BP) is the next stage in the development of preeclampsia. Hypertension precedes changes in the kidneys and the development of nephropathy. In chronic diseases of the heart and blood vessels, hypertension forms faster and proceeds with a large number of complications.

The following indicators testify to hypertension in pregnant women:

increase in systolic blood pressure by 30 mm Hg. Art. from the original;
increase in diastolic blood pressure by 15 mm Hg. Art. from the original.

Severe complications during pregnancy are usually associated not with an increase in blood pressure, but with its fluctuations. In this regard, sharp rises and falls in blood pressure are much more dangerous than the consistently high pressure in the expectant mother.

Nephropathy... The main symptom of nephropathy in pregnant women is proteinuria (the appearance of protein in the urine). At the same time, there is a decrease in the daily amount of urine (oliguria) to 500 ml or less. Severe oliguria may indicate the development of renal failure.

The likelihood of developing nephropathy increases with chronic kidney disease. Pyelonephritis, glomerulonephritis - all these conditions can become a provoking factor. Against the background of kidney disease, nephropathy of pregnant women is more severe and is often accompanied by the development of complications.

Complications of nephropathy

Inadequate treatment of nephropathy and hypertension of pregnancy can lead to the development of preeclampsia. This condition is characterized by the following symptoms:

headache;
nausea and vomiting;
visual disturbances (flashing of flies before the eyes, the appearance of a veil);
insomnia or severe drowsiness;
memory impairment.

Preeclampsia can quickly turn into eclampsia with the development of generalized seizures. Loss of consciousness occurs during an attack. After the seizures resolve, the woman may regain consciousness or fall into a coma. Eclampsia most often develops during childbirth or in the postpartum period against the background of high blood pressure and renal dysfunction.

Not only eclampsia threatens a pregnant woman. Against the background of pronounced spasm of the uterine arteries, chronic placental insufficiency develops. As a result, the baby does not receive oxygen in the amount he needs. There is fetal hypoxia, leading to a delay in its intrauterine development. This condition can result in various health problems for the newborn, including a noticeable delay in mental and physical development.

Pregnancy nephropathy is one of the causes of premature birth. Often, obstetricians have to perform an emergency caesarean section at any stage of pregnancy in order to save a woman's life. Placental abruption and bleeding may also be a reason for surgery.

Diagnostics

every 14 days - up to 30 weeks;
every 7-10 days - after 30 weeks.

This approach allows you to timely detect any abnormalities in the work of the kidneys, including nephropathy. The development of the disease is evidenced by the appearance of protein in the urine. The combination of this symptom with arterial hypertension and edema is an unfavorable sign and indicates a high risk of serious complications.

Proteinuria (protein in the urine) is a late sign of nephropathy. To detect the disease in the early stages, all pregnant women need to monitor their weight and blood pressure. To assess the condition of the fetus, ultrasound and Doppler blood flow in the uterine, placental and fetal vessels are performed.

Treatment principles

Treatment of nephropathy of pregnant women is carried out in a hospital. With this pathology, the risk of sudden development of complications is very high, therefore, a pregnant woman should be under round-the-clock supervision of a doctor. In the course of therapy, blood pressure, body weight and daily urine output must be monitored.

Antihypertensive therapy (drugs that stabilize blood pressure).
Infusion therapy (drugs to improve hemodynamics and blood coagulation properties.
Angicoagulants (drugs that prevent blood clots).
Normalization of uteroplacental blood flow.
Treatment of accompanying complications of pregnancy.

The question of the due date is decided individually. Indications for early delivery may include the following situations:

severe course of nephropathy;
lack of effect from treatment;
delayed fetal development of the III degree;
eclampsia;
bleeding and other complications.

Natural childbirth is possible if the condition of the woman and the fetus is satisfactory (according to laboratory examinations and ultrasound). With the development of complications, a cesarean section is performed.

Prophylaxis

Specific drug prevention of nephropathy and severe preeclampsia has not been developed. Pregnant women are advised to closely monitor their condition, monitor weekly weight gain and blood pressure numbers. Timely treatment of diseases of the kidneys, heart and blood vessels also reduces the risk of developing nephropathy and all dangerous complications of this condition.

Nephropathy and its classification

Late toxicosis begins with the appearance of edema (dropsy), can turn into nephropathy of pregnant women, as well as preeclampsia (high blood pressure and the presence of protein in the urine) and eclampsia - the last and most severe phase of preeclampsia with seizures. Moreover, this transition can be either gradual or rapid. The cause of the formation of nephropathy in pregnant women has not been established for certain. There is an assumption that the problem is still associated with impaired blood circulation, namely, its decrease in internal organs and including the uterus, placenta, kidneys. The RAS (the hormonal system that regulates blood pressure) responds to all these changes, and the level of antidiuretic hormone produced by the body increases. It happens:

primary, manifested by an increase in blood pressure, edema, proteinuria (protein in the urine), occurs in women with healthy kidneys;
and secondary, manifests itself against the background of previously existing diseases: glomerular nephritis and other renal diseases, including hypertension, heart defects, aortic insufficiency with an increase in blood pressure, while the risk of adverse consequences for the mother and child increases.

The incidence of this disease varies from 2.2 to 15.0%. To this day, nephropathy of pregnant women remains one of the leading "culprits" of maternal mortality in the world (its share is 20-33%). About 50,000 women die each year. The main causes of death are:

CNS damage (hemorrhagic and ischemic stroke, cerebral edema);
pulmonary edema;
liver necrosis;
acute DIC syndrome.

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Symptoms of nephropathy

Nephropathy in pregnancy usually presents with three symptoms: hypertension, swelling, and the presence of protein in the urine. This combination is diagnosed in 50-60% of patients. A doctor can already diagnose nephropathy when at least two symptoms are found, but a single manifestation also occurs.

Hydrocephalic syndrome

The most common manifestation of nephropathy is hydrocephalic syndrome. Taking into account that under normal conditions of pregnancy, blood pressure practically does not change, it can be considered unlikely that hypertension will turn into a malignant form. The situation is much more dangerous if a woman already had health problems associated with hypertension before pregnancy. If so, then late toxicosis is more difficult.

Edematous syndrome

Edema syndrome ranks second in frequency of diagnosis in pregnant women. This phenomenon is associated with the retention of water and chloride in the body. Swelling can occur on different parts of the body and if the legs just swell, then this is not so critical, but when such phenomena as swelling of the face, hands, legs, thighs appear, it is worth consulting a doctor to prevent circulatory disorders in a pregnant woman and, as a result, restoring normal oxygen access to the fetus. The presence of edema can be easily checked by pressing a finger in the intended place, and if there is a dent, then it can be argued that there is one.

Kidney damage

Nephropathy in pregnant women primarily disrupts the work of the kidneys and if at the initial stages (in a mild form of manifestation) the excretion of protein in the urine does not affect health and disappears without a trace soon after childbirth, then with a complex form of flow negative impact on them, the daily excretion of urine decreases, while the level of protein in it increases. There is a chance of developing kidney failure. There are also symptoms of fundus transformations (retinal edema, minor hemorrhages and foci of degeneration). With stabilization of blood pressure, stabilization of the fundus is also noted, otherwise a decision may be made on urgent delivery.

Pathogenesis of the disease

Exists a large number of hypotheses about what is the reason for the appearance of nephropathy in pregnant women, among the total number, the following can be distinguished:

Dysfunctions of the central nervous system(set on the EGS before the manifestation of symptoms), pathology is formed due to a violation of the mechanisms of the higher parts of the NS to the reorganization of processes in the body of a pregnant woman. This sufficiently explains the disorders of the vascular system that characterize nephropathy.
Disruption of hormonal balance, metabolic products accumulate in the uterus, which provokes an increase in the production of adrenal hormones, which further forces the kidneys to actively produce the hormone renin, which is produced outside of them.
An immunological conflict between a mother and a child with the appearance of circulating immune complexes, while the fetus is accepted by the mother's body as a foreign object, since it owns half of the father's antigens.
Previously proceeded and existing diseases: diabetes, overweight, hypertension, heart disease, nephritis and glomerulonephritis.

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Diagnosis of nephropathy during pregnancy

When diagnosing this disease, the gynecologist primarily relies on the above three main symptoms, namely: hypertension, swelling and the presence of protein in the urine. Of fundamental importance is the competent management of pregnancy: timely measurements of blood pressure, control of weight gain, passing urine analysis, and determining the daily volume of urine. If necessary, the pregnant woman is sent for additional consultations and studies (ultrasound, ECG, biochemical blood tests) to other specialists (ophthalmologist, cardiologist). All these measures will allow you to recognize the disease in advance and take the necessary measures.

Complications

With early diagnosis and treatment of nephropathy in pregnant women, the outcome is generally favorable. Normalization of the condition occurs either after 3-7 days after childbirth, or within a month and a half. Puffiness disappears, hypertension disappears, kidney function is restored (previously harmful changes are not found in the renal tissue).

When a diagnosis of preeclampsia is made, there are signs of pernicious hypertension (headaches, nausea, vomiting) up to mental disorders, the temperature rises, and respiratory arrest is possible. Initially, an attack of eclampsia manifests itself in a slight shuddering of the muscles of the face, eyelids, then there are tonic convulsions, up to clonic. But the most undesirable consequences of a severe form of nephropathy in pregnant women include uterine bleeding in the mother, placental abruption, fetal hypoxia, miscarriage.

Nephropathy treatment

strict monitoring of blood pressure, kidney function, checking the content of electrolytes;
adherence to a diet (table number 7), reducing the daily absorption of salt to 1.5-3 g, liquid up to 1 liter with an even distribution, fat consumption is reduced to 0.7-1 g per 1 kg of weight, foods rich in carbohydrates and potassium, fasting days;
drug therapy: drugs are used to restore protein loss, normalize hemodynamics at the macro and micro levels, sedatives that allow the central nervous system to work, medicines to relieve angiospasm.

To prevent swelling, diuretics are administered in various combinations at the same time or sequentially. If necessary, diuretic agents are prescribed, they should be combined with a sufficient intake of potassium. Only after a full course of therapy and elimination of all symptoms of nephropathy in pregnant women can the question of discharge be raised. But even being at home, you should adhere to the recommendations:

adhere to the diet prescribed by your doctor;
take walks on fresh air for better blood supply to the placenta;
absorb the required amount of liquid;
avoid stress.

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Treatment outcome

The positive point is that in the treatment of nephropathy of pregnant women, in most cases, natural childbirth... Caesarean section is prescribed in cases where therapy has not yielded the desired result (for example, high blood pressure is still maintained), there is a threat of placental detachment or hypoxia. If the use of conservative therapy does not give the desired effect, then there are indications for urgent (urgent) delivery, that is, for a cesarean section.

Childbirth with nephropathy

It is usually possible to cure nephropathy, maintain and achieve a normal completion of pregnancy with correct treatment and compliance with the regimen, as well as all the recommendations of the doctor by the patient. During the birth itself, you need to notify the doctor, carefully monitor the condition of the mother and child, make a competent approach to pain relief and examine the newborn for the possibility of hypoxia. As a rule, already soon after the birth of a child, the woman disappears clear signs of nephropathy: edema, hypertension, kidney function returns to normal.

Prophylaxis

As with all aspects of health, it is important to provide competent prevention aimed at avoiding the development of the disease. Under no circumstances should you miss appointments, examinations and analyzes by a doctor, monitor your own condition on your own. You need to be especially careful in matters of prevention if there is a predisposition, since the likelihood of the manifestation of the disease becomes higher, as does the rapidity of aggravation of symptoms.

If a more complex form of nephropathy has been transferred, then such phenomena as changes in urine and hypertension may also occur in the postpartum period. In such cases, it becomes a question of setting a special control (dispensary), which is set for a year, during which it is supposed to carry out therapy and accounting at least once every 3 months. This control is carried out under the guidance of a therapist and nephrologist. After the expiration of the term, a further decision is made on whether it is worth stopping or extending the dispensary registration, taking into account the results obtained.

In the international classification of diseases 10 revision, preeclampsia of moderate severity is called nephropathy of pregnancy. In the Russian Society of Obstetrician-Gynecologists, this pathology is called gestosis. Symptoms of nephropathy in pregnancy develop after 20 weeks of gestation. The pathology is based on a widespread spasm of microvessels and a violation of the blood supply to internal organs, which entails their failure.

What leads to the development of nephropathy?

An increase in the number of patients with diabetes mellitus, hypertension and overweight women leads to an increase in the frequency of preeclampsia during the period of gestation. It is the main etiological factor in neonatal morbidity and ranks third among the causes of maternal mortality.

In the development of nephropathy, 2 factors play a role:

Placental. If, at the time of formation of the placenta, its incomplete germination into the spiral arteries of the uterus occurs, then its insufficient blood supply and ischemia develop. To compensate for this condition, vascular active substances (inflammatory mediators, interleukins, tumor necrosis factor) are released. But gradually they damage blood vessels and pass into the mother's blood. This leads to the development of vascular dysfunction in other organs.
The maternal factor is a disease that a woman had before pregnancy and aggravate the damage to the microvascular system. These include diabetes mellitus, arterial hypertension, kidney disease, and fat metabolism disorders.

In some women, nephropathy can be predicted. The following conditions increase the risk:

chronic stress leads to a frequent release of substances that affect vascular tone, while the adaptive abilities of the body are impaired;
pregnancy with existing diseases of the cardiovascular system, kidneys, endocrine pathologies (including hyperthyroidism), cholecystitis, hepatitis, vegetative-vascular dystonia and obesity;
hereditary predisposition, maternal gestosis;
with diseases of the immune system, increased allergization;
the age of the pregnant woman is up to 17 years;
in women who have suffered nephropathy during the previous bearing of a child;
chronic infections;
smoking;
malnutrition.

A deficiency of vitamins, a sedentary lifestyle of a pregnant woman have a great influence on the formation of pathology.

The mechanism of the formation of pathology

The pathogenesis of nephropathy is based on the release of vasoactive substances by the placenta, which leads to generalized vasospasm. In the kidneys, blood flow and glomerular filtration are reduced. This increases serum creatinine. Sodium is retained by the kidneys, while preventing water from leaving. Protein permeability increases and is excreted in urine.

The kidney senses ischemia and, to eliminate the problem, secretes substances that further increase vasospasm. The amount of aldosterone decreases, but vascular permeability increases, which leads to the release of fluid into the tissue and the formation of edema. The volume of the circulating fluid decreases.

All kidney functions are gradually disrupted: hormonal, excretory, filtration, resorption and regulatory, the amount of protein in the urine increases.

Classification

The classification of nephropathy is based on clinical manifestations. It is characterized by edema of varying severity. Dropsy of pregnant women can be hidden and visible.

Explicit edema is divided into 4 degrees:

Swelling of the legs.
Lower limbs + abdomen.
Accession of edema of the face.
Anasarka, total edema.

The severity of nephropathy itself is assessed using the Savelyeva scale. Each pathological condition is assigned its own number of points, their sum is an indicator of severity. Grade 1 nephropathy of pregnant women - up to 7 points, moderate severity - 8-11 points, severe nephropathy - 12 or more.

Concomitant diseases are those that worsen the condition and increase the risk of developing pathology.

Manifestations of nephropathy

The main clinical signs that distinguish nephropathy of pregnant women from mild preeclampsia are the classic triad:

Swelling.
Proteinuria.
Arterial hypertension.

Symptoms do not appear all at once, usually there is a gradual addition of signs of nephropathy. Edema is often the first to appear. Sometimes this is a latent form of dropsy, which can be suspected of pathological weight gain. Weight increases by 600 g or more per week. The systolic pressure rises by 20-30 mm Hg. Art. from the original, and the diastolic 15 mm Hg. Art. After a while, proteinuria joins the first symptoms. Sometimes the classic triad of signs is not observed, one or two of them appear in a pregnant woman.

With the normal progression of pregnancy, blood pressure practically does not change. In women with preeclampsia, a significant increase in pressure can lead to overloading of the left ventricle of the heart and the development of pulmonary edema.

Symptoms accompanying nephropathy in pregnant women

If nephropathy develops against the background of previously existing hypertension, then its course is more aggressive and quickly reaches 3 degrees. An isolated rise in only diastolic pressure with a low systolic pressure is considered an unfavorable phenomenon that deserves special attention.

Increased pressure leads to characteristic changes in the fundus. In this case, the following signs are observed:

swelling of the nipple of the optic nerve;
spasm of arterioles;
traces of hemorrhage.

Sometimes, with pronounced pathological conditions of the fundus, a decision may be made about early delivery. But if the pressure returns to normal, then pathological changes disappear. Preservation of signs of eye pathology persist with existing chronic pyelonephritis or hypertension.

Protein in the urine can be combined with traces of red blood cells (microhematuria) or cylindruria. If hematuria is significantly pronounced, then nephropathy is combined with glomerulonephritis.

Mild nephropathy of pregnant women can aggravate its course, while additional symptoms appear:

headache;
drowsiness or a state of agitation;
dyspeptic disorders in the form of nausea, vomiting;
behavioral disorder, irritability, tearfulness, frequent mood swings;
impairment of vision, hearing, speech;
feeling of heat.

The appearance of a hoarse voice, difficulty in nasal breathing, coughing speaks of widespread edema and is an unfavorable sign. Itching, the appearance of rashes of pain in the right hypochondrium - evidence of liver damage.

The fact that a condition of 2 severity is progressing and is at risk of becoming eclampsia is indicated by the following symptoms:

impaired consciousness of varying severity, an extreme condition is a coma;
detachment of the retina and a sharp drop in vision;
acute renal failure;
respiratory failure and signs of pulmonary edema;
acute liver failure and HELLP syndrome;
premature placental abruption;
cerebral hemorrhage;
convulsions.

Nephropathy after childbirth, if it does not occur against the background of pre-existing hypertension and kidney disease, usually goes away and does not lead to the persistence of severe symptoms. Otherwise, the disease can aggravate its course.

Complications associated with nephropathy

Pathological conditions that occur during pregnancy affect the condition of the fetus. Complications can be as follows:

intrauterine growth retardation in combination with feto-placental insufficiency;
fetal asphyxia and hypoxia, which can result in antenatal loss of the child;
premature detachment of a normally located placenta;
premature delivery or spontaneous interruption of gestation up to 22 weeks.

The consequences of nephropathy in pregnant women are manifested in labor disorders. Blood pressure can begin to rise during labor, leading to abnormalities in labor. During childbirth and the postpartum period, the risk of bleeding increases.

Methods for diagnosing the disease

At each visit to the gynecologist, a pregnant woman is prescribed a urine test, blood pressure is measured and the presence of edema on the legs is shown. Weighing is mandatory. These simple techniques allow you to notice pathological symptoms at an early stage and to carry out appropriate treatment.

The results of all measurements are entered into the pregnant card. This allows you to dynamically monitor the course of pregnancy.

When the first symptoms of nephropathy appear, carry out additional examination to reveal the degree of pathological changes:

coagulogram;
Ultrasound of the kidneys, liver;
blood chemistry;
measurement of daily urine output;
fetal cardiotocography after 27 weeks of gestation;
Ultrasound of the fetus and determination of uteroplacental blood flow;

In many cases, an examination by an ophthalmologist is appointed, who assesses the condition of the fundus. According to the indications, a consultation is carried out with a nephrologist, endocrinologist, cardiologist. Other diagnostic methods may be used depending on the specific case.

Treatment methods

Treatment of nephropathy of pregnancy is determined by the severity. At 1-2 degrees, hospitalization is needed in the department of pregnancy pathology. For severe nephropathy, treatment is carried out in the intensive care unit.

In the conditions of the maternity hospital, a therapeutic and protective regime is created, which allows to reduce the load on the nervous system. Be sure to adhere to bed rest and a general decrease in physical activity. A woman needs good sleep and rest.

The diet should be balanced. The daily salt intake is necessarily limited to 3 g, the amount of liquid is reduced to 1.3-1.5 liters. This takes into account all drinks, soups, juicy fruits.

Medication includes medications to lower blood pressure. For this, intravenous drip infusion of a solution of magnesium sulfate is carried out. It has a hypotensive effect, reduces the tone of the uterus, improves placental blood flow.

To reduce vasospasm, antispasmodics are prescribed: Drotaverin, Papaverine, Platifillin. Diuretics that are administered after a dropper, for example, Furosemide, Hydrochlorothiazide, help to reduce swelling.

Under the control of a coagulogram, antiaggregants and anticoagulants are prescribed to improve the rheological properties of blood. It can be Aspirin in small doses, Dipyridamole, Pentoxifylline. The duration of their use is determined individually.

Correction of metabolic and electrolyte disorders, restoration of organ blood flow, the amount of protein is carried out through infusion therapy. Plasma infusion helps maintain sufficient clotting factors to prevent bleeding. Correction electrolyte composition occurs due to solutions of Polyglyukin, Reopoliglyukin, Ringer, dextrose, saline solutions.

Herbal treatment for nephropathy in pregnant women is supportive and distracting. Traditional methods not able to affect pathological changes in the vessels. When using only herbal medicine, the risk of the disease becoming a serious condition increases.

The choice of delivery time depends on the effectiveness of the treatment. For mild nephropathy, treatment is carried out within 2 weeks. If it does not have a pronounced effect, then termination of pregnancy is indicated.

Treatment of moderate nephropathy is carried out for 5-6 days. Severe nephropathy is subject to emergency treatment in the intensive care unit. If there is no effect of treatment within 3-12 hours, then emergency delivery is indicated. For this, a caesarean section is performed, in which endotracheal anesthesia is used.

Prevention of gestosis and its complications

So that the symptoms of nephropathy do not come as a surprise, timely prevention is necessary. It should be started before conception with examination and elimination of the pathology of the cardiovascular system, treatment of chronic kidney disease, diabetes mellitus. It is necessary to achieve a stable remission of these pathologies. For overweight women, a diet to reduce weight is recommended.

During pregnancy, a woman should get enough rest and not go to bed too late. But at the same time, one must not forget about motor activity... You can do some gymnastic exercises on your own or in schools for pregnant women.

Nutrition for the period of gestation should be balanced in terms of essential nutrients. Additionally, take multivitamin complexes. Restriction of table salt is imperative. It is recommended to cook dishes without salt, and add salt directly on your plate.

Women from risk groups for the formation of nephropathy at a critical time are prescribed drugs that improve placental blood flow, reduce tone. This is Curantil, Magne B6.

Pregnant women need to follow all doctor's instructions. If the therapy is effective, then the pregnancy is prolonged until the maturity of the fetus. After suffering severe nephropathy, a woman should be followed up for a year by a therapist. This is necessary in order to timely treat the consequences of pathology in the form of a persistent increase in pressure, kidney damage, changes in the fundus. Subject to the doctor's prescriptions and proper treatment, the prognosis for nephropathy is favorable.

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Nephropathy of pregnant women is not a disease, but a condition that develops against the background of pathological processes in the body associated with the appearance in the patient of such a complication as gestosis.

Gestosis is called late toxicosis, this disease is due to several reasons, under an unfavorable combination of circumstances, it can lead to fetal hypoxia or intrauterine death.

at this stage, the condition becomes dangerous, it can cause the development of hypoxia in the fetus, requires urgent hospitalization and further drug treatment in the hospital.

Third stage

The most dangerous stage in the development of nephropathy, against the background of the course of the pathological process, the level of blood pressure rises sharply, the protein concentration reaches 5 g / l. The pressure rises above 170/110 mm Hg. A pregnant woman has local edema, pathological weight gain, and a decrease in urine outflow.

The third stage is dangerous for both the mother and the child, it can cause intrauterine fetal death or lead to premature onset of labor.

The first thing you should pay attention to is the presence of dropsy - edema. At the first stage of the development of nephropathy in pregnant women, only the lower extremities swell, after the edema passes to the hands and face, the abdominal wall region, at the third stage, edema is observed throughout the body.

Symptoms of manifestation

Most often, in pregnant women suffering from nephropathy, the following symptoms are observed:

swelling;
arterial hypertension;
the appearance of protein in the urine.

This is a characteristic triad of symptoms, but there are other signs that bother a woman with the development of nephropathy:

nausea and vomiting;
intense thirst;
weakness, high fatigue;
increased sweating;
pain in the lumbar region;
a decrease in the volume of a portion of urine.

Depending on the stage, the symptomatology changes, its manifestations intensify. This threatens the life of the mother and child.

Flow phases

At the initial stage of the development of the condition, there is an increase in the level of blood pressure, the appearance of edema.

Both legs and fingers can swell, the first sign of the development of preeclampsia is that a woman cannot remove the rings from her fingers.

At the second stage, a significant increase in blood pressure is observed, the concentration of protein in urine also increases, and edema appears on the face. There is a violation of the outflow of urine.

The portion of urine is significantly reduced, no more than 40 ml of urine leaves the pregnant woman per hour.

At the third stage, the symptoms intensify, severe weakness, swelling appear, the pressure exceeds 170/110, which undoubtedly affects the woman's condition. There is a violation of blood flow to the placenta, the fetus develops hypoxia and other pathologies.

The danger of nephropathy in pregnant women is that it can develop in 2 scenarios:

In the first case, the pathology progresses slowly, appropriate drug therapy allows you to compensate for the condition and preserve the pregnancy, bring it to its logical conclusion.
In the second case, the state quickly progresses, instantly passes from one stage to another, as a result of which the woman's condition deteriorates significantly.

Most often, the condition is diagnosed in patients after 20 weeks, less often it is observed from the beginning of pregnancy.

Who will he contact, methods of diagnosis?

Since the gynecologist is monitoring a pregnant woman, he should suspect the development of a pathological condition.

The doctor can connect the following specialists to the patient's treatment:

endocrinologist;
cardiologist.

When making a diagnosis, a number of procedures are carried out that will help differentiate nephropathy from diseases similar in symptomatology (pyelonephritis, glomerular nephritis, etc.).

with dopplerography;
urine analysis (various samples, including biochemistry,);
ECG of the heart and ultrasound;
hardware monitoring of blood pressure level.

Therapies

If we talk about the treatment of nephropathy in pregnant women, then it takes place in several stages, it is necessary to take medications, follow a diet and limit fluid intake. And also gynecologists recommend staying in bed.

Traditional remedies

To compensate for the condition, a number of drugs are prescribed that will help cope with the unpleasant symptoms of nephropathy.

These medicines include:

Hirudotherapy is also quite effective, it is used at stages 2 and 3 of the development of nephropathy. Hirudotherapy of the temporal region will help reduce the intensity of severe symptoms, it is applied on a regular basis.

ethnoscience

They are highly effective in this condition. They are recommended to be eaten every day if it is possible to prepare lingonberry juice.

A glass of lingonberry juice a day will be enough, just don't drink it right away. Divide the juice into 2-3 servings.

Herbal preparations are also used, you can cook them yourself, it is enough to mix the following ingredients in the dishes in equal proportions: coltsfoot, nettle, St. John's wort, yarrow, bearberry.

Stir dry raw materials and pour boiling water (30 g. Of the mixture will require 300 ml of boiling water.).

You can brew bearberry. Having prepared a strong infusion: 2 tbsp. Pour tablespoons of herbs with a glass of boiling water, darken in a water bath for 20 minutes, let stand for 2 hours. Then strain and drink. Repeat the procedure 3-4 times a day.

Treatment outcome

The effectiveness of therapy directly depends on when the treatment was started, how the condition develops, whether there is a threat of intrauterine fetal death or premature labor.

Treatment ends when the woman gives birth to the baby. After childbirth, the edema subsides, the level of blood pressure decreases and stabilizes. In this case, no further treatment is required.

Childbirth with pathology

If the condition does not progress, it is compensated for with medication, then the woman has every chance of delivering the baby to the term and giving birth on her own, without the help of doctors.

If early contractions began, the pathological process affected the liver, there were disturbances in the work of the brain, intrauterine hypoxia appeared, then it is required to carry out caesarean section on an emergency basis.

Complications and consequences

The consequences of pathology can be different. The most difficult is considered intrauterine fetal death, death of a mother or child during labor. And also complications include:

the development of fetal hypoxia;
the presence of various malformations in the infant;
premature birth.

Prevention and prognosis

At the initial stages of the development of nephropathy in pregnant women, provided that the condition is compensated, does not progress and does not go into stage 3, the prognosis can be considered favorable.

At the 3rd stage of the development of nephropathy, the prognosis is poor, since the likelihood of complications is high.

As a preventive procedure, carry out:

Ultrasound of the kidneys (in the presence of swelling or previous diseases);
dopplerography and planned ultrasound of the fetus;
ECG and monitoring of maternal blood pressure.

Nephropathy of pregnancy is a serious pathological condition that can lead to consequences. If the pathology develops rapidly, progresses, then it poses a threat to the health of the mother and fetus and can be fatal.

Late toxicosis manifests itself in the form of diseases such as:

dropsy - excessive accumulation of fluid in the subcutaneous fat, tissues;
nephropathy of pregnancy - toxic kidney damage during pregnancy;
preeclampsia and eclampsia.

Nephropathy and its classification

Late toxicosis begins with the appearance of edema (dropsy), can turn into nephropathy in pregnant women, as well as preeclampsia (high blood pressure and the presence of protein in the urine) and eclampsia - the last and most severe phase of preeclampsia with seizures. Moreover, this transition can be either gradual or rapid. The cause of the formation of nephropathy in pregnant women has not been established for certain. There is an assumption that the problem is still associated with impaired blood circulation, namely, its decrease in internal organs, including the uterus, placenta, kidneys. The RAS (the hormonal system that regulates blood pressure) reacts to all these changes, and the level of antidiuretic hormone produced by the body increases. It happens:

primary, manifested by an increase in blood pressure, edema, proteinuria (protein in the urine), occurs in women with healthy kidneys;
and secondary, manifests itself against the background of previously existing diseases: glomerular nephritis and other renal diseases, including hypertension, heart defects, aortic insufficiency with an increase in blood pressure, while the risk of adverse consequences for the mother and child increases.

CNS damage (hemorrhagic and ischemic stroke, cerebral edema);
pulmonary edema;
liver necrosis;
acute DIC syndrome.

Symptoms of nephropathy

To determine the diagnosis, the doctor prescribes a urine test.

Hydrocephalic syndrome

Edematous syndrome

Kidney damage

Nephropathy primarily disrupts kidney function and can lead to the development of kidney failure.

Nephropathy in pregnant women primarily disrupts the work of the kidneys and if at the initial stages (in a mild form of manifestation) the excretion of protein in the urine does not affect health and disappears without a trace soon after childbirth, then with a complex form of flow, the negative effect on them reduces the daily urine output, at the same time, the level of protein in it increases. There is a chance of developing kidney failure. There are also symptoms of fundus transformations (retinal edema, minor hemorrhages and foci of degeneration). With stabilization of blood pressure, stabilization of the fundus is also noted, otherwise a decision may be made on urgent delivery.

Pathogenesis of the disease

There are a large number of hypotheses about what is the reason for the appearance of nephropathy in pregnant women, among the total number the following can be distinguished:

Dysfunctions of the central nervous system (set on the EGS before the manifestation of symptoms), pathology is formed due to a violation of the mechanisms of the higher parts of the NS to the reorganization of processes in the body of a pregnant woman. This sufficiently explains the disorders of the vascular system that characterize nephropathy.
Disruption of hormonal balance, metabolic products accumulate in the uterus, which provokes an increase in the production of adrenal hormones, which further forces the kidneys to actively produce the hormone renin, which is produced outside of them.
An immunological conflict between a mother and a child with the appearance of circulating immune complexes, while the fetus is accepted by the mother's body as a foreign object, since it owns half of the father's antigens.
Previous and existing diseases: diabetes, overweight, hypertension, heart disease, nephritis and glomerulonephritis.

Diagnosis of nephropathy during pregnancy

Additional diagnostics will allow you to recognize the disease in advance and take the necessary measures.

- the clinical form of late toxicosis, which in typical cases includes a triad of symptoms: edema, arterial hypertension and proteinuria. Sometimes nephropathy of pregnancy is manifested by the two named symptoms; rarely, with a monosymptomatic course - one (hypertension or proteinuria). Diagnosis of nephropathy in pregnant women is based on the detection of obvious and latent edema, high blood pressure, protein in the urine in III trimester pregnancy. Treatment of nephropathy of pregnant women is carried out in an obstetric hospital and includes the appointment of a protective regime, diet, antihypertensive, diuretic, sedatives.

General information

Late toxicosis of pregnancy (gestosis) includes pathological conditions that arise in the second half of gestation and pass after the termination of pregnancy or childbirth. Gynecology includes dropsy, nephropathy of pregnant women, preeclampsia and eclampsia, which are simultaneously stages of one pathological process, to late toxicosis. Usually, late toxicosis begins with dropsy (edema), then it can turn into nephropathy of pregnancy, preeclampsia and eclampsia. The transition from one form of toxicosis to another can be gradual, with an aggravation of symptoms, or very fast, lightning fast.

Distinguish between primary nephropathy, which developed in pregnant women with an uncomplicated somatic history, and combined late toxicosis, which occurs against the background of pre-existing pyelonephritis, glomerulonephritis, hypertension, heart defects (secondary nephropathy of pregnant women). Among the factors of perinatal child and maternal mortality, nephropathy of pregnancy is one of the main causes. The incidence of nephropathy in pregnant women, according to various studies, ranges from 2.2 to 15.0%.

Causes of nephropathy in pregnant women

It is believed that the onset of nephropathy is associated with the failure of the adaptive mechanisms of the pregnant woman's body to its new state. Nephropathy of pregnant women is characterized by generalized spasm of arterioles, changes in hemodynamics, increased vascular permeability, decreased BCC, impaired microcirculation of vital organs, which leads to hypoxia, metabolic disorders, primarily, impaired water-salt and protein metabolism.

There are several hypotheses explaining the reasons for the development of nephropathy in pregnancy. One of the theories puts forward the moment of accumulation in the ischemic placenta and uterus as a decisive factor. harmful products exchange. Among the toxic metabolites, there are antigens that cause the formation of antigen-antibody complexes with their subsequent sedimentation in the kidneys and damage to the renal glomeruli. In addition, the placenta begins to produce vasopressor substances that lead to widespread spasm of the arterioles. It is possible that thromboplastins coming from the ischemic placenta into the general bloodstream provoke the development of DIC syndrome, accompanied by repeated thromboembolisms of the vessels of the kidneys and lungs.

Another theory of the development of nephropathy in pregnant women is based on the hypothesis of hormonal imbalance. Metabolic products accumulating in the ischemic placenta and uterus stimulate the production of prostaglandins and vasoconstrictors, adrenal hormones (aldosterone, catecholamines), renin synthesis of the renin hormone and its extrarenal production by the uterus and placenta itself.

A significant role in the development of nephropathy in pregnant women is assigned to immunological conflicts between the mother and the fetus with the formation of CICs, including IgG, IgM, C3-complement fraction. Against this background, biologically active substances are produced in the body of a pregnant woman - acetylcholine, histamine, serotonin, etc.

In the occurrence of nephropathy in pregnant women important point is a dysfunction of the central nervous system, as evidenced by changes in the EEG of the brain, noted even before the development of symptoms of toxicosis. Pregnancy nephropathy often develops during the first pregnancy, multiple pregnancies. Hypertension, obesity, heart defects, diabetes mellitus, previous pyelonephritis and glomerulonephritis predispose to the development of nephropathy in pregnant women.

Circulatory disorders that develop in the kidneys lead to fluid and sodium retention in tissues (edema), the appearance of protein in the urine (proteinuria), and excessive release of renin into the blood leads to persistent vascular spasm and an increase in blood pressure. With nephropathy of pregnant women, the myocardium, liver, and cerebral vessels also suffer. Due to impaired placental circulation, fetal malnutrition and hypoxia may develop.

Symptoms of nephropathy in pregnancy

Pregnancy nephropathy usually develops after the 20th week of pregnancy. Its occurrence is preceded by dropsy of pregnant women, characterized by the appearance of latent and obvious persistent edema with normal blood pressure and the absence of protein in the urine. With an unfavorable development, dropsy passes into the next stage of toxicosis - nephropathy of pregnant women.

A constant sign of nephropathy in pregnant women is progressive arterial hypertension with an increase first in diastolic and then systolic blood pressure. Proteinuria increases 3-6 weeks after hypertension is detected. The severity of edema varies from slight pastiness of the hands and face to extensive swelling of the whole body. According to the severity of symptoms, there are 3 degrees of severity of nephropathy in pregnant women.

At grade I, blood pressure is not higher than 150/90 mm Hg. Art .; proteinuria is up to 1 g / l; swelling of the lower extremities is noted. II degree of nephropathy in pregnant women is characterized by an increase in blood pressure to 170/110 mm Hg. Art. (with a pulse difference of at least 40); proteinuria up to 3 g / l, the appearance of hyaline casts in the urine; edema in the lower extremities and in the region of the anterior abdominal wall; diuresis of at least 40 ml per hour. With III degree of nephropathy of pregnant women, blood pressure increases by more than 170/110 mm Hg. Art. (with pulse amplitude less than 40); proteinuria exceeds 3 g / l, granular casts are found in the urine; swelling becomes generalized; diuresis decreases less than 40 ml per hour.

Also, with nephropathy of pregnant women, thirst, dizziness, poor sleep, weakness, shortness of breath, dyspepsia, flatulence, blurred vision, and back pain are noted. With liver damage, pain occurs in the right hypochondrium, an increase in the size of the liver, sometimes jaundice appears. In the case of myocardial damage, the development of ischemic myocardiopathy is noted.

With an early onset and long-term course of nephropathy in pregnant women, it is more likely to progress to the following stages - preeclampsia and eclampsia. Nephropathy of pregnant women can lead to spontaneous abortion, fetal growth retardation, premature placental abruption, fetal hypoxia or asphyxia, premature and complicated labor (abnormalities in labor, bleeding).

Diagnostics of the nephropathy of pregnant women

Nephropathy of pregnant women is detected by a gynecologist observing a woman by characteristic symptoms. In this case, the classic triad of nephropathy occurs only in 50-60% of pregnant women, the rest may have one or two signs.

The recognition of nephropathy in pregnant women is facilitated by the competent management of pregnancy with regular measurement of blood pressure, dynamic control of weight gain, determination of the volume of urine output, and a general urine analysis. To clarify the state of the placenta and the fetus, doppler ultrasonography of the uteroplacental blood flow, cardiotocography, fetal phonocardiography, obstetric ultrasound are performed. When examining the fundus in women with nephropathy of pregnancy, signs of narrowing of the arteries and varicose veins are found.

Nephropathy of pregnant women is differentiated with pyelonephritis, glomerulonephritis, symptomatic hypertension, adrenal tumors (pheochromocytoma, Conn's syndrome). An ophthalmologist, nephrologist, endocrinologist, neurologist, cardiologist can be involved in the diagnosis of nephropathy in pregnant women. Additionally, it may be necessary to conduct ultrasound of the kidneys and adrenal glands, ECG, biochemical blood and urine tests, coagulogram, urine culture, determination of hormones (renin, aldosterone, catecholamines).

Treatment of nephropathy of pregnancy

In case of nephropathy, inpatient treatment is required; with I and II degrees - in the general department of pathology of pregnant women, with III degrees - in the ICU. In the hospital, careful monitoring of blood pressure, electrolyte content, and renal function is carried out.

A prerequisite for treatment is compliance with medical and protective measures: bed rest, good rest and sleep, taking sedatives. The diet for nephropathy of pregnant women consists in limiting the daily intake of salt to 1.5-2.5 g, liquid to 1 liter, and fat. The daily diet should contain a sufficient amount of protein, fruits, vegetables, foods rich in potassium and carbohydrates. Fasting days (kefir, dried fruit curd, etc.) are held weekly.

Drug therapy is aimed at relieving angiospasm, normalizing micro- and macrohemodynamics, and compensating for protein loss. For nephropathy of pregnant women, the first-line drugs are antispasmodics (papaverine, platifillin, drotaverine), antihypertensive drugs (magnesia sulfate), diuretics, potassium preparations, antiplatelet agents (dipyridamole), protein drugs (plasma, albumin), etc. Infusion therapy for nephropathy of pregnant women is carried out under control of BCC, diuresis, hematocrit, electrolytes. With nephropathy of pregnant women, sessions of hirudotherapy, oxygen barotherapy can be prescribed. With the ineffectiveness of conservative treatment of nephropathy (within 1-2 weeks at grade I and 1-2 days at grade III), the pregnant woman requires urgent delivery.

Prognosis for nephropathy of pregnant women

Subject to the regimen and the adequacy of therapy, nephropathy of pregnant women is usually curable. In the case of stopping the phenomena of nephropathy, pregnancy can be saved. During childbirth, monitoring of the condition of the fetus and the woman in labor, careful pain relief, and prevention of fetal hypoxia are required. Subsequently, it is necessary to examine the newborn for intrauterine hypoxia, intensive observation by a neonatologist. After childbirth, the woman's edema, hypertension, proteinuria disappear, and the kidneys are restored.

The early appearance and persistent course of nephropathy in pregnant women is prognostically unfavorable for the fetus and mother. Persistent forms of nephropathy often turn into preeclampsia and eclampsia, which can result in intrauterine fetal death and the death of a pregnant woman.

Prevention of nephropathy in pregnant women

During pregnancy, systematic monitoring of blood pressure, weight gain, renal excretory function of the pregnant woman, timely detection and relief of the initial manifestations of toxicosis is necessary. Pregnant women with extragenital pathology, which serves as a background for the development of nephropathy, need particularly careful observation by an obstetrician-gynecologist.

Nephropathy most often develops against the background of an unrecognized or insufficiently properly treated dropsy of pregnant women. Less commonly, symptoms of nephropathy occur without a previous stage of late toxicosis - dropsy of pregnant women. Nephropathy of pregnant women is characterized by a triad of symptoms: edema, increased blood pressure (hypertension) and the presence of protein in the urine (proteinuria). However, with nephropathy, not three, but two of the above symptoms are often expressed: hypertension and edema, hypertension and proteinuria, edema and proteinuria. Swelling can be pronounced or insignificant, and even hidden; in some cases, this symptom is not detected by clinical research methods. Increased blood pressure is the most constant symptom of nephropathy. Hypertension is a clinical manifestation of the main pathogenetic factor of late toxicosis - a violation of the nervous regulation of the vascular system. Blood pressure in nephropathy rises to varying degrees. In severe cases of the disease, the maximum (systolic) pressure reaches 180-200 mm Hg. Art. and higher; sometimes it does not exceed 135-140 mm Hg. In patients with nephropathy who suffered from vascular hypotension before pregnancy, an increase in blood pressure sometimes manifests itself in the fact that it reaches a normal level. In such cases, a symptom of nephropathy is an increase in blood pressure by 20-30 mm Hg. Art. compared to the original. With nephropathy of pregnant women, the diastolic (minimum) pressure also increases, which is associated with an increase in the tone of arterioles and peripheral resistance. Inherent in nephropathy, disturbances in the nervous regulation of the functions of the vascular system are manifested not only in an increase in blood pressure; often there is an uneven increase (asymmetry) in blood pressure in the vessels of the right and left halves of the body, changes in pressor-depressor reactions in response to thermal and other stimuli, lability or torpidity of reactions or their perversion. Nephropathy is characterized by spasm of arterial and expansion of venous capillaries, spastic state of arterioles, slowing of blood flow in the capillary system, increased permeability of the walls of the smallest vessels and increased release of salts, water and finely dispersed serum proteins (albumin) from the blood into the tissues. Violation of blood circulation in the capillary system is clearly detected with capillaroscopy, as well as with ophthalmoscopy. In severe forms of nephropathy, narrowing of the arteries and dilatation of the veins of the fundus, and sometimes edema of the retina, are often found ophthalmoscopically. With nephropathy (especially with severe and prolonged course), the amount of circulating blood (hypovolemia) often decreases. Proteinuria is one of the most characteristic signs of nephropathy in pregnant women. Usually, traces of protein appear in the urine first; as toxicosis develops, proteinuria increases. The presence of traces of protein should alert the doctor; its increase to 1 g / l and more gives reason to consider this phenomenon as a sign of nephropathy. Proteinuria in nephropathy can reach high numbers, but in most cases it does not exceed 5-8 g / l. The cause of proteinuria is increased vascular permeability of the renal glomeruli; an increase in the permeability of the renal glomerular filter is an expression of the general changes inherent in the vascular system. With prolonged vasospasm of the kidney vessels, their trophism changes, proteinuria increases, hyaline casts appear. With a severe course of nephropathy and further deterioration of kidney function, granular and even waxy cylinders appear in the urine. Diuresis is often reduced. Vascular disorders characteristic of nephropathy entail a deterioration in oxygen delivery to the tissues; severe forms of nephropathy are usually accompanied by hypoxia. In connection with it, oxidative processes deteriorate, changes occur not only in water-salt, but also in protein and fat metabolism. In the body, the amount of under-oxidized products increases, the reserve alkalinity of the blood decreases, and there is a tendency to acidosis. Changes in metabolism are also expressed in a decrease in the total amount of proteins in the blood serum, a change in the ratio of protein fractions towards an increase in globulins, in a tendency to hypovitaminosis. With a severe and prolonged course of nephropathy, not only changes occur in the nervous, vascular and excretory (kidney) systems, but also the functions of the liver (protein-forming, antitoxic, carbohydrate, etc.), hematopoietic organs (anemia, leukocytosis, neutrophilia, lymphopenia) and some endocrine glands. In particular, dystrophic changes and hemorrhages in the placenta often occur. There are three degrees of severity of nephropathy. The first degree of severity is characterized by slight edema, moderate hypertension (blood pressure not higher than 150/90 mm Hg at the initial normal level) and the presence of protein in the urine up to 1 g / l. Second degree of severity: severe edema, blood pressure rises to 40% to the initial level (above 150/90 to 170/100 mm Hg. Art. At an initial level of 120/70 mm Hg. Art.), protein in urine up to 2-3 g / l. The third degree of severity: pronounced edema, an increase in blood pressure by more than 40% to the initial data (maximum above 170-180 mm Hg), severe proteinuria (protein above 3 g / l), cylindruria and oliguria. Such a division of nephropathy. is not recognized by everyone, because there is no strict correlation in the increase in the severity of these symptoms (edema, proteinuria, hypertension). Many obstetricians distinguish between mild (I degree) and severe (II-III degree) forms of nephropathy of pregnant women. Nephropathy of pregnant women often occurs against the background of previous diseases (essential hypertension, nephritis, etc.) and is more often observed in primary pregnant women. Nephropathy usually occurs in last months pregnancy, has a protracted course and often continues until childbirth (its manifestations either weaken or intensify). After childbirth, complete recovery occurs. However, after severe and long-term nephropathy, there are often consequences in the form of persistent hypertension. Nephropathy presents a danger in relation to the transition to preeclampsia and eclampsia. This applies primarily to severe and protracted forms of nephropathy, as well as to those that began long before the end of pregnancy. The earlier the nephropathy begins and the more severe its course, the worse the prognosis for the mother (transition to preeclampsia and eclampsia) and the fetus. With these features of the course of nephropathy, fetal development retardation may occur: in such cases, newborns show signs of malnutrition and functional immaturity. With a severe and prolonged course of nephropathy, premature termination of pregnancy sometimes occurs: in some cases, the fetus dies before the onset of childbirth. Adverse outcomes for the fetus are more often observed in nephropathy that has arisen against the background of hypertension, nephritis and other diseases. The course of childbirth in patients with nephropathy may be common, but complications often arise: fetal asphyxia, abnormalities of labor forces, bleeding, etc.; during childbirth, the threat of the transition of nephropathy to the next stage of toxicosis (preeclampsia, eclampsia) increases. Recognition of nephropathy is not difficult: its manifestations are established as a result of the use of generally accepted research methods (examination, weighing, measuring blood pressure, urine, blood, etc.). Often there is a need for differential diagnosis between nephropathy and nephritis. The latter is characterized by the corresponding anamnestic data, the content in the urine not only of cylinders, but also of leukocytes and erythrocytes, left ventricular hypertrophy, an increase in residual nitrogen in the blood, and other treatment. It is carried out in a hospital; hospitalization is necessary even for mild latent forms of the disease. The patient is prescribed bed rest, creating conditions for emotional and physical rest. Prescribe a hypochlorite and predominantly dairy-vegetable diet; the amount of salt is limited to 2-3 g, liquid - up to 600-700 ml per day; the amount of fat is reduced to 60-70 g per day (butter and vegetable oil). The patient should receive complete proteins (boiled meat, fish, cottage cheese, kefir) at the rate of 2 g per 1 kg of the pregnant woman's body weight, as well as carbohydrates (up to 500 g per day). The letter should contain vitamins (fresh fruits, vegetables, juices); in case of their lack, it is necessary to administer vitamins. With severe hypoproteinemia, a solution of dry plasma can be injected intravenously. In order to remove the products of impaired metabolism from the body, fasting days (cottage cheese or apples) are prescribed. To improve protein metabolism, methionine is recommended 1 g 2-3 times a day, as well as parenteral administration of protein drugs. great importance the use of sedatives (motherwort infusion, valerian preparations, trioxazine, etc.), as well as hypnotics, if the use of sedatives is not enough to regulate sleep. Thermal irritation of the skin (heating pads) of the lower back in the kidney area can contribute to a reflexive decrease in blood pressure. edema, ammonium chloride, dichlothiazide, diacarb are used. The main objectives of treatment for nephropathy include the elimination of disorders of the vascular system. Various drugs are used that reduce high blood pressure and help eliminate hypoxia and metabolic disorders associated with disorders of the vascular system. During the first day, magnesium sulfate is recommended (20 ml 25% solution 4 times a day intramuscularly); on the 2nd and subsequent days, the dose of the drug is reduced depending on the degree of decrease in blood pressure and the patient's condition. Magnesium sulfate has a hypotensive effect, promotes increased urine output, lowers the excitability of the nervous system. Magnesium sulfate can be administered by electrophoresis, and can also be used with chlorpromazine (contraindicated in diseases of the liver, kidneys, hematopoietic organs, etc.); at the same time, the daily dose of both drugs is halved. Injections of magnesium sulfate (15-20 mm 25% solution 2 times a day) alternate with the administration of chlorpromazine (1 ml of a 2.5% solution intramuscularly 1-2 times a day or by mouth 25 mg 1 -2 times a day). Aminazine can be used in combination with reserpine (0.1-0.25 mg orally 2-3 times a day for 1-2 weeks), diphenhydramine or pipolfen. The use of chlorpromazine can cause a significant drop in blood pressure, so close observation of the patient is necessary. You can recommend other drugs that help lower blood pressure (aminophylline orally, 0.1 g 2-3 times a day, dibazol in combination with glucose, etc.), as well as sodium bromide (orally or intravenously 5 ml of 10% solution 1 time per day for 7-10 days). Rutin with ascorbic acid (0.2 g) and calcium gluconate (0.5 g) are used 2-3 times a day. Glucose is injected intravenously (20-40 ml of a 40% solution). Treatment for nephropathy is long-term, so you have to replace one remedy with another, change doses, prescribe remedies in different combinations. If the use of these funds is unsuccessful and the arterial pressure is high, hirudotherapy is performed (6 leeches per mastoid area). In case of severe nephropathy and the absence of the effect of conservative therapy, bloodletting (250-300 ml) was previously used. At present, bloodletting is not used, since it is difficult to predict the amount of blood loss during childbirth, and a collaptoid state may develop in response to blood loss. During childbirth, the treatment of nephropathy is continued (magnesium sulfate, chlorpromazine, etc.), thorough anesthesia is carried out, in severe nephropathy, childbirth ends with the imposition of obstetric forceps.With high blood pressure and the threat of preeclampsia and eclampsia in some institutions, viadril is used in combination with droperidol, method of controlled relative hypotension by gangliolytic agents. For this purpose, arfonad, pentamine and other drugs (arfonad - in a 0.1% solution, pentamine - in a 0.5% solution 50-70 drops per minute) are injected intravenously, and blood pressure is lowered to 140 / 100-120 / 80 mmHg Art. After that, the introduction of the solution is slowed down and regulated so as to keep the blood pressure at the target level. Controlled hypotension is indicated predominantly in the second and third stages of labor.