Chronic nephritis and pregnancy

772

THE

AMERICAN

JOURNAL

OF

OBSTETRICS

AND

GYNECOLOGY

There was slight rigidity over the right rectus and a large smooth mass, 8 to 12 cm. in diameter, was easily palpable in the right lower quadrant. The mass was tender to deep palpation and was quite freely movable. On vaginal examination, the cervix was found patulous, the uterus about twice normal size, and both ovaries had been converted into cystic masses easily S to 19 cm. in diameter. The cystic right ovary constituted the tumor felt on abdominal palpation. The uterus was normal, the hemoglobin 65 pclr cent and the leucocytes 7500. A diagnosis of lutein cysts of the ovaries was made and laparotomy performed under nitrous oxide-oxygen anesthesia. The uterus was found to bc of about twice the normal size, as one would expect after less than one month’s involution. The tubes were normal, but both ovaries had been transformed into multi!,ocular lutrin Cysts, the right 14 cm. in diameter and the left 12. Salpingo-oophorohystercctomy was performed, the conralescensc was unrventful and the patient left the hospital on the fourteenth day after operation. The pathologist reported epithelioma, occupying the

bilateral lutcin cysts of the ovary right side of the uterine fundus.

and

an area

of chorio.

This case presents the follo\ving points of interest: A diagnosis of hydatidiform mole confused by the insistence of an intelligent multipara t!lat she felt fetal movements. The very rapid development of large lutein cysts of both ovaries after expulsion of a mole. The presencr of chorioepithelioma in the furdus uteri one month after the termination of a mole pregnancy. 1814

SPRUCE

STREET. (For

Beckers:

Chronic

Nephritis

and

Pregnancy.

discussio,tc,

Bruseltes-rnotl.

see page

7:

1237,

885.)

19%.

Pregnancy, undoubtedly, has a deleterious influence on chronic nephritis. This may be due to digestive troubles, in which an increased absorption of toxic products They must be eliminated by the kidneys. In some cases occurs in the intestines. the colon bacillus may pass by way of the blood stream to the kidneys thus causAgain, during pregnancy, there is an increase ing a pyelitis or pyelonephritis. of the nitrogenous products to be excreted, which is in direct opposition to the Further, the uterine enlargement may cause best treatment of chronic nephritis. circulatory disturbances. Finally, compression of one or both ureters will lead to retention of nitrogenous products. lesions called the nephritis of Occasionally pregnancy may give rise to renal pregnancy. That fetal life is in some way bound up etiologically with these conditions is shown by the fact that the albuminuria often disappears upon intrauterine death and before expulsion of the f&us. Approaching trouble is manifested by retention of chlorides with edema. Here the treatment should be a salt-free diet. A straight milk diet is objectionable because of its high salt and fluid contents, also might cause a nitrogenous retention. In severe cases, ,only water should be allowed and free purgation instigated. In the milder cases the diet should be restricted to fruits and green vegetables. At times therapeutic abortion may become neczessary. Where arterial hypertension is the outstanding feature, a strictly vegetable diet should be adhered to, combined at times with blood letting. THEODORE W. ADAMS.