The prognosis in acute and chronic nephritis of pregnancy from the standpoint of classification

Abstract

The classification of nephritis of pregnancy as acute and chronic and the study of renal function in the individual case is an aid to prognosis.Patients with acute nephritis rarely give a history of previous renal trouble. The presence of albuminuria, the rather sudden rise in blood pressure, and increased edema usually occur during the eighth or ninth month. Tests of renal function show adequate excretion, aside from oliguria, the specific gravity of the urine is high, and the ocular fundi may reveal evidence of acute changes in the vessels and retina.Patients with chronic nephritis often give a history of previous nephritis. Albuminuria, hypertension, and edema are apparent earlier in pregnancy, usually before the seventh month. Tests of renal function often disclose retention of nitrogen and phenolsulphonephthalein. The specific gravity of the urine is fixed or low, and there is definite secondary anemia. Examination of the ocular fundi often reveals changes resulting from previous nephritis.Most pregnant women with acute nephritis recover with little or no demonstrable impairment of renal function. In some cases the disease will progress to the chronic stage. Many pregnant women with a history of nephritis but with no gross impairment of renal function can be carried safely through pregnancy under careful supervision. Chronic nephritis with seriously lowered renal function distinctly increases the hazard to mother and child.