Reversible hypertension in pregnancy caused by obstructive uropathy.

BACKGROUND

Hypertension with deterioration of renal function after mid-pregnancy often signifies preeclampsia and the need for delivery.

CASES

We have encountered three women with reversible hypertension related to obstructive uropathy. The women presented between 21-30 weeks' gestation with hypertension accompanied by significantly increased serum creatinine. Although pregnancy-induced hypertension was considered initially in all, there was no other evidence of preeclampsia. In all three, ureteral obstruction was confirmed radiographically and found to be associated with uterine overdistention or congenital urinary anomalies. Relief of obstruction by ureteral stent placement or percutaneous nephrostomy was followed by diuresis and resolution of hypertension. In all three women, pregnancy was extended by more than 6 weeks.

CONCLUSION

Urinary obstruction is a rare but potentially reversible cause of hypertension in pregnancy. Relief of obstruction may lead to normalization of blood pressure and negate the need for immediate delivery.