Abstract:

Pregnancy with hypertension, proteinuria, edema detected in third trimester is always preeclampsia unless proven otherwise¹. We had a similar case with acute onset of hypertension, proteinuia, oedema, mild breathlessness along with frank hematuria at 32 weeks of gestation in a primigravida. She was initially diagnosed as preeclampsia with its complication either HELLP syndrome or DIC. Investigations showed sever anaemia, mild thrombocytopenia normal liver & kidney function normal coagulation studies without any evidence of sepsis. Surprisingly fetal parameters were absolulety normal. There was no evidence of Intrauterine Growth restriction, fetal, and uterine Doppler studies were normal. Renal Doppler showing paranchymal renal disease. Patient was stabilized in ICU with nasal Oxygen, diuretics, antihypertensive, antibiotics, steroids for fetal pulmonary maturity. In view of deteriorating maternal condition uncontrolled hypertension increasing hematuria urgent delivery by caesarian section done as bishops was very poor. Surgery went uneventful with outcome of male child of 1.7 kgs. Post surgery patient was hemodynamically stable hypertension well controlled but hematuria was persistent and fluctuant. Urine culture report was negative. Suspecting some renal pathology with nephritic syndrome like presentation, she was found to be ASO titer positive. Detailed history revealed pharyngitis 4-5 days before with altered voice since then. Repeat renal uitrasonography 15 days postdelivery showed same findings of altered corticomedullary differentiation, raised cortical echogenicity suggestive of medical renal disease with normal renal artery Doppler. Final diagnosis of nephritic syndrome was made and patient was discharged on day 16 with fluctuant hematuria. Hematuria completely cured over 3 months period.

References:

[1.]   http:// www.merck.com/mmpe/sec17/ch235b.html

[2.]   Julia B. Lewis, Eric G, Neilson: Glomerular diseases; Harrison Principles of Internal Medicine 17^th edition, chp 277 page1784, editor: Anthony S. Fauci.

[3.]   Julia B. Lewis, Eric G, Neilson: Glomerular diseases; Harrison Principles of Internal Medicine 17^th edition, chp 277 page1785-87, editor: Anthony S. Fauci.

[4.]   McGraw – Hill, Williams Obstetrics, 23 ed, Chapt 34, Pregnancy Hypertension.

[5.]   McGraw – Hill, Williams Obstetrics, 23 ed, Chapt 48. Renal and Urinary Tract Disorders.

[6.]   Sibai M, Renal Diseases & Pregnancy B, Glob.libr.womens med, Glowm.10157, 2008.