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When one thinks of pregnancy, the thought of a successful, uneventful, healthy pregnancy comes to mind.  However, as a medical professional we know that this is not always the case.  Pregnancy is in fact a very stressful health risk to the mother.  Once you have added a preexisting medical condition, the risk to the mother and baby increases.  One of the most physiologcially stressed organs in the human body during pregnancy are the kidneys.  We know that pregnancy is a hyperdynamic and hypervolemic state for the pregnant patient, in fact the renal blood flow increases by 70% to 85% above the nonpregnant state.   Kidney disease is a major health problem for the pregnant patient; it may lead to other maternal and fetal complications and increase mortality and morbidity for both mother and fetus.  Furthermore, kidney disease is a relatively uncommon disorder in the pregnant patient population.

This presentation represents the current recommendations for hemodialysis in the pregnant patient. We will discuss a patient whom was 20 years of age and of Hispanic descent. The patient was an illegal immigrant transferred to our institution from a tertiary care center.  The patient was a gravida 2, para 1 whom presented to us at  29 weeks gestation without any prior prenatal care other than the initial presentation to the transferring hospital.

The woman was previously diagnosed with kidney dysfunction after her first delivery two years prior in Mexico. After the initial diagnosis the patient was to have follow up care, however the patient did not receive the follow up care required.  Upon presentation to the hospital the patient was found to be in end stage renal disease and would require hemodialysis.

A multi-disciplinary approach was a necessity in the care of this patient.  We will discuss the care of this patient at our institution and the outcome. We will differentiate between the care of the normal healthy pregnant patient and patient with renal failure.  Also, discussion of the treatment options for anesthesia and pregnancy induced hypertension will be discussed as part of the plan of care for delivery.