Nusrat H. than  ( Department of Obstetrics and Gynaecology, Dow Medical College and Civil Hospital, Karachi. )

The Current view regarding renal disease complicat­ing pregnancy suggests that there are no adverse effects on the kidney if kidney function is only moderately compromised in the absence of hypertension^1-5. Sustenance of a viable pregnancy depends mainly on the degree of functional impairment rather than on the underlying parenchymal disease. Polycystic kidney dis­ease should be included in the differential diagnosis of abdominal masses associated with pregnancy. An un­usual case of renal disease associated with pregnancy is presented.

A 25 year old primigravida was admitted with acute abdominal pain at 29 weeks unsure gestation. On examination she was clinically anaemic, uncomfortable but not in acute pain. She was normotensive and pulse was 100/minute, regular and good volume. Temperature was normal. On abdominal examination a huge cystic mass was filling the whole abdomen. Fluid thrill was present. Foetal parts were felt on the right side. Presenting part was cephalic and foetal heart rate was 140/mt regular. Pervaginam examination was inconclusive. Cervix was however closed. There was definite history of pain in the left renal region rediating to the back and dysuria since the first trimester of the pregnancy. Symptomatic treatment had been given by local general practitioners from time to time. An ultrasound examination done two days prior to admission revealed a huge, cystic, partially scptate mass arising from the pelvis, extending to the left hypochondrium and epigastrium with a single active foetus of 29 weeks gestation. A presumptive diagnosis of ovarian cyst complicating pregnancy was made. At laparotomy, a 18 cm x 10 cm left retroperitoneal cyst was found pushing the transverse colon, splenic flexure and descending colon to the midline and the gravid uterus of 30 weeks gestation to the right. Right kidney was normal. Both ovaries were normal. A left-sided nephrectomy was done. Foetal cardiac activity remained normal throughout the uneventful postopera­tive period. Histopathological examination confirmed the diagnosis of polycystic kidney disease. Spontaneous labour commenced at 35 weeks gesta­tion. Second stage of labour was expedited by elective outlet forceps with episiotomy. A live male infant weigh­ing 2.2 kg was delivered. Apgar scores were 7 at 1 minute and 10 at 5 minutes. Unfortunately, on the 5th postnatal day the baby expired 2 hours after feeding (neonatal death).The same patient, however, booked for hospital confinement in her second pregnancy at 26 weeks gestation. All renal function tests remained normal throughout. A live female infant weighing 2.7 kg was delivered at 38 weeks gestation. She failed to attend the post natal clinic on both occasions.

Renal disease is known to be associated with intrauterine growth retardation^2,6. Average birth weights are low since most deliveries are preterm. In child bearing age, usually the functional impairment is minimal and hypertension absent leading to favourable outcome in delivery⁷. This was so in the present case.

The writer wishes to thank Dr. Mumtaz Maher for performing the nephrectomy and Dr. S.A.H. Zaidi for the histopathological examination.

1. Bear, ltA. Pregnancy in patients with renal disease; a study of 44 cases. ObateL Gynaecol., 1976:48:13-18.
2. Felding, CF. Obstetric aspects in women with histories of renal disease. Acta Obstet. GynaccoL Scand., l969;48 (suppl.2. 2):1-43.
3. Kaplan, AL.. Smith, J.P. and Tillman, A.3.B. Healed acute and chronic nephritia in pregnancy. Am.J.Obstet.Gynecol., l962;83:15l9-25.
4. Studd, J.W.W. and Baliney. J.D. Chronic renal disease in pregnancy. Br.J.Hosp.Med., 1970;2:248-53.
5, Werko, Land Bucht. H. Glomerular filtration rate and renal blood flow in patients with chronic diffuse glomerulonephritia during pregnancy. Acta Med. Scand., 1956;153:177­-86.
6. Strauch, B.S. and Hayslett, J.P. Kidneydiacaaeand pregnancy. Br.Med,3,, 1974;4:578-82.
7. Reeders, S.T., Zerres, K., Gal, A., Ilogenkamp, T., Propping, P., Schmidt, W., Waldhrrr, R., Dolata, MM. Davies, K.E. and Weatherall, 0.3. Prçnatat diagnosis of autoaomcl dominant polyrystic kidney diaeasewith a DNA probe. Lancet, 1986;2:6-7.