Acute renal failure is a rare, but serious complication during pregnancy. It may cause significant morbidity or mortality. The physiological effects of pregnancy can compromise renal function due to the enlarged kidneys, dilated ureters, and increased blood volume. It is reported that pregnant patients with known compromised kidney function have a 43% rate of loss of kidney function. A compromised renal system places the patient at risk for academia, fluid/electrolyte imbalance, and pregnancy complications. When advanced to acute renal failure, more intrusive treatments are needed. Unfortunately, it is difficult to manage the renal failure during the pregnancy, the problem worsening while the gestational age increasing..            We recently experienced a 29 year old, Gravida 4, Para 2, 1, 0, 2 with chronic kidney disease and hypertension. On admission, at 26 and 6 weeks, her creatinine was 4.6 and blood pressure of 127/82. The fetal heart rate was 145 with normal variability. At her first prenatal visit, her creatinine was 3.8. At 28 weeks her creatinine was 5.1, which prompted her to be started on hemodialysis for approximately 5-6 hours per day.            The significance of her worsening kidney function resulted in a collaborative multidisciplinary approach to her care. The goal for the medical management of her was to treat the cause, prevent further damage, and provide supportive care until recovery occurs, prolong the gestation and maintain the mother and baby well-being. This required collaboration between the dialysis and high risk nurses to be sure that the interventions were not compromising the others. The interventions included daily rounds with the medical and nursing team to discuss the status of the mother and fetus. The duration of the dialysis required continuous maternal and fetal monitoring. Ongoing assessment and anticipation of the patients needs were completed by the nurses. It was critical that any change in condition was evaluated for further progression of disease. In addition, her dietary and psycho-social needs were addressed. It was critical she maintain an appropriate diet. It is unclear if her kidney function return to after the pregnancy and post-partum period, so extensive counseling and planning is already occurring.  

The diagnosis of acute renal failure required planning for the anticipated delivery and well being of the baby, but also long term planning for the mother. Significant learning from this patient include providing “on the spot” education for nursing, support for the nursing staff, and a multidisciplinary approach to care. This included multiple physicians and nursing specialties, dietary, social work and case management meeting frequently to discuss the latest condition of the patient. The openness of all parties involved with the patient and fetus’ interest staying in the forefront contributed to the health and well being of this patient.