Michalska Magdalena, Wen Kevin, Pauly Robert P
Royal Alexandra Hospital, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Can J Kidney Health Dis. 2019 Jul 22;6:2054358119861942. doi: 10.1177/2054358119861942. eCollection 2019.
With increasing number of complex medical patients with renal transplant who get pregnant, clinicians need to be aware of abdominal compartment syndrome which may masquerade as acute renal allograft injury in pregnancy.
A 34-year-old nulliparous Caucasian female with end-stage renal disease (ESRD) due to type 1 diabetes mellitus who received a simultaneous pancreas-kidney transplant (SPK) in 2006 and then after rejection of renal allograft another, kidney-only allograft from a donation after circulatory death became pregnant in May 2013 with dichorionic, diamniotic twins without reproductive technology, and during pregnancy, she developed two episodes of acute injury to the renal allograft.
End-stage renal disease secondary to type I diabetes, acute renal allograft injury, tacrolimus toxicity, abdominal pain.
She received intravenous hydration, medications contributing to renal failure were held, and pain and nauseas were controlled appropriately. Abdominal compartment syndrome was managed by maintaining intravascular pressure and optimizing regional and systemic vascular perfusion by appropriate fluid balance, evacuating intraluminal contents by decompressing gastrointestinal system, and improving abdominal wall compliance by using appropriate analgesics, sedation, and patient positioning.
With advancing pregnancy, the patient developed progressive abdominal pain, nausea, leg edema, and rising creatinine that were not responsive to ongoing therapies and required delivery via Cesarean section at 31 weeks of gestational age.
In the era of increasing number of pregnant renal transplant patients with multiple medical issues, we need organized approach to diagnosis of acute renal allograft injury in pregnancy and we need to consider abdominal compartment syndrome as one of the causes.
随着越来越多接受肾移植的复杂医学患者怀孕，临床医生需要意识到腹腔间隔室综合征，该综合征在孕期可能伪装为急性肾移植损伤。
一名34岁未育的白人女性，因1型糖尿病患有终末期肾病（ESRD），2006年接受了胰肾联合移植（SPK），之后肾移植发生排斥反应，又于2013年5月接受了来自循环死亡后捐赠的单肾移植，自然受孕怀有双绒毛膜、双羊膜囊双胞胎，孕期发生了两次肾移植急性损伤。
1型糖尿病继发终末期肾病、急性肾移植损伤、他克莫司中毒、腹痛。
她接受了静脉补液，停用了导致肾衰竭的药物，并适当控制了疼痛和恶心症状。通过维持血管内压力、通过适当的液体平衡优化局部和全身血管灌注、通过减压胃肠道排出腔内内容物以及使用适当的镇痛药、镇静剂和调整患者体位来改善腹壁顺应性，从而处理腹腔间隔室综合征。
随着孕周增加，患者出现进行性腹痛、恶心、腿部水肿和肌酐升高，持续治疗无效后，于孕31周行剖宫产分娩。
在患有多种医学问题的怀孕肾移植患者数量不断增加的时代，我们需要有组织的方法来诊断孕期急性肾移植损伤，并且需要将腹腔间隔室综合征视为病因之一。
