Hemodialysis Initiation During Pregnancy for Advanced CKD Due to ANCA-Associated Glomerulonephritis
Bibliographic record
Abstract
Introduction: Initiation of dialysis during pregnancy is uncommon. Here we describe a woman with advanced CKD due to ANCA-associated glomerulonephritis (GN) requiring initiation of hemodialysis in the early third trimester of pregnancy. Case Description: A 37-year-old woman with hypertension, rheumatoid arthritis, and CKD stage 4 secondary to ANCA-associated GN in remission for six years presented with an unplanned pregnancy. Pre-pregnancy medications included rituximab (for RA) and losartan, both stopped at pregnancy diagnosis. Labs during early pregnancy: Creatinine (Cr) 2.24 mg/dl (eGFR 28), BUN 35 mg/dl, Hb 8.9 g/dl, UACR 0.56 g/g, 2+ hematuria. At 32 weeks, she was admitted for intrauterine growth restriction (IUGR) and worsening renal function. Her blood pressure was 125/79 mmHg on nifedipine and labetalol. Admission labs revealed Cr 3.04 mg/dl (eGFR 20), BUN 40. ANCA serologies were negative. Urine prot:cr ratio was 2.9 g/g without hematuria. She was diagnosed with intrauterine growth restriction. At 32 weeks 3-day gestation, she started hemodialysis 6 days/week for 5-6 hours per session. She was diagnosed with pre-eclampsia with severe features based on severe-range blood pressure despite antihypertensive therapy. Labor was induced at 34 weeks, resulting in a vaginal delivery with favorable maternal and fetal outcomes. Postpartum, she was discharged on home hemodialysis (4 days/week) and then transitioned to peritoneal dialysis with plans for kidney transplantation. Discussion: CKD is associated with adverse pregnancy outcomes, including preeclampsia, preterm birth, IUGR, and pregnancy loss. Experts recommend initiating dialysis in pregnancy when the eGFR <20 or BUN >50–60 mg/dl—earlier than in non-pregnant patients. Hladunewich et al showed that intensive HD (>36 hrs/wk) in a Canadian cohort resulted in improved pregnancy outcomes as compared with conventional HD. Asamiya et al. found that maintaining BUN <49 mg/dl correlated with higher birthweight and gestational age at delivery among pregnant patients on dialysis. However, most patients in these studies were on dialysis before conception, with limited data on those who initiated dialysis during pregnancy. More research is required to guide timing and intensity of dialysis initiation during pregnancy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".