Case report: Pregnancy in hemodialysis-dependent end-stage renal disease: anesthetic considerations

Purpose: To describe the obstetrical and anesthetic management of a parturient with end-stage renal disease. Clinical features: A 38-yr-old woman had severe renal impairment due to Wegener's granulomatosis. She was on hemodialysis for 12 years following two failed kidney transplants. She had two unsuccessful pregnancies, two and 12 years previously. The antenatal care of the present pregnancy incorporated a multidisciplinary approach involving obstetrics, nephrology and anesthesiology. Labour was induced at 36 weeks gestation. Bupivacaine 0.0625% with fentanyl 2 mu g(.)mL(-1) was injected through an epidural catheter inserted for labour analgesia. Lidocaine 2% with epinephrine 2.5 mu g-mL(-1) was given later for Cesarean delivery. There was no associated maternal or neonatal morbidity. The management focused on minimizing hemodynamic disturbances while providing maximum pain relief. Conclusions: For a successful outcome in the parturient with end-stage renal disease, a multidisciplinary approach is essential.