Management of Pregnancy With Kidney Failure : A Case Report

Abstract

Background: Acute kidney injury (AKI) superimposed on chronic kidney disease (CKD) during pregnancy is associated with high maternal and fetal morbidity, including metabolic disturbances and intrauterine fetal death (IUFD). Early multidisciplinary management is essential to improve outcomes. Case Presentation: A 33-year-old woman, G3P2A0H2, at 34–35 weeks of gestation with two previous cesarean sections was referred with acute on CKD, metabolic acidosis, severe hypokalemia, anemia, and IUFD. She presented with progressive dyspnea for three days and absent fetal movement for three weeks. Ultrasonography confirmed singleton IUFD at 34–35 weeks of gestation. Laboratory examination showed Hb 6.8 g/dL, creatinine 3.4 mg/dL, urea 96 mg/dL, potassium 2.5 mmol/L, metabolic acidosis, and hypocalcemia. The patient was managed with oxygen therapy, electrolyte and acid–base correction, bicarbonate therapy, calcium supplementation, and packed red cell transfusion. Clinical and laboratory improvement was achieved during hospitalization, with suspected underlying Gitelman or Bartter syndrome contributing to refractory hypokalemia. Conclusion: Pregnancy complicated by AKI on CKD may result in severe maternal metabolic complications and IUFD. Prompt stabilization and multidisciplinary management are crucial to optimize maternal condition and guide further obstetric management