Nephritic Toxemia is a serious toxemia, sometimes complicating pregnancy, and though it may occur at any time during the period of gestation, it usually develops during the latter months. As a rule, it is simply an exacerbation and accentuation of a previously existing, chronic nephritis, of which the patient may, or may not, have been aware; though in some instances the disability of the kidneys may arise during pregnancy. In many cases, so far as the kidneys are concerned, the patient is entirely normal in the non-pregnant state, and even during pregnancy, up to a certain point; then her kidneys prove to be unequal to the added metabolic strain of pregnancy, and signs of renal insufficiency appear.
Such a patient will suffer from toxemia, with each recurring pregnancy, the symptoms almost always appearing earlier, and with increased severity, with each pregnancy, as the permanent damage to the kidneys is increased by each successive attack.
Chart 1.—Chart showing relatively rapid disappearance of albumen from the urine and return of blood pressure to normal, after delivery in eclampsia.
Symptoms. The symptoms in nephritic toxemia are practically the same as those in chronic nephritis: lassitude, headache, visual disturbances, edema, high blood pressure and casts and large amounts of albumen in the urine. In some instances, the patient suffers such slight discomfort that the increased blood pressure and urinary symptoms are the only precursors of coma, and possibly convulsions which cannot be distinguished from an eclamptic seizure.
As the patient may die in the coma, no matter how suddenly it develops, the value of regular urinalyses and observations upon the blood pressure, which are included in prenatal care, must once more be mentioned.
In severe, chronic cases infarcts (hemorrhagic or necrotic areas) appear in the placenta. These may be extensive enough to interfere with the nourishment of the fetus, which, being already weakened by the toxic effects of the disease, is unable to survive. As a result, nephritic toxemia is second only to syphilis in causing premature deaths. When the child dies, the symptoms usually begin to subside in a week, or possibly two, and the dead fetus is expelled.
Treatment and Nursing Care. The treatment and nursing care are virtually the same as for pre-eclamptic toxemia; rest in bed, milk diet, forced fluids, purges, and in addition, observations upon the intake and output of fluids. The output of urine will not equal the amount of fluid which the patient takes in, at first, but in those patients who improve, the amount of urine gradually increases until it equals the amount of fluid ingested. The edema and other symptoms improve, except the high blood pressure and the albumen in the urine, which sometimes persist for months. (Chart [2].)
If the patient has coma or convulsions, the treatment is the same as in eclampsia.
A patient with inadequate kidneys who has never been able to carry a child to term may sometimes achieve this coveted end by going to bed a few weeks before the period in her pregnancy when the toxic symptoms have usually appeared, taking only milk for food, drinking large amounts of water, and keeping her bowels moving freely.