title: Circulating angiogenic factors in a pregnant woman on intensive hemodialysis: a case report.
abstract: BACKGROUND
  Pregnancy in patients on chronic hemodialysis therapy, though unlikely, does happen rarely. Intensive hemodialysis is thought to offer a better survival advantage to the unborn child. Circulating angiogenic factors are helpful for prognostication of pregnant patients with chronic kidney disease who are not on dialysis. Data on their utilization in dialysis patients, however, are limited.
  
  
  METHODS
  We report the case of a patient with a history of interstitial nephritis who had a kidney transplant that failed after 8 years due to membranous nephropathy. She was initiated on hemodialysis three sessions per week and conceived after being on dialysis for 6 weeks. She was switched to intensive hemodialysis at 8 weeks of gestation and had a C-section because of hypertension at 35 weeks, with delivery of a healthy girl weighing 2012 g. Serum angiogenic factors (placental growth factor and soluble fms-like tyrosine kinase) were measured at 32, 33, and 34 weeks of gestation and at 1, 2, and 3 weeks postpartum. Serum angiogenic factors were similar to what has been reported for patients with chronic kidney disease and were not consistent with preeclampsia.
  
  
  CONCLUSIONS
  Our case report expands on the literature regarding intensive hemodialysis and angiogenic factor utilization in pregnant dialysis patients. Our case report suggests that starting intensive dialysis early in pregnancy is safe and concentration of angiogenic factors are similar to those reported for patients without kidney disease, except for PIGF levels, which are somewhat higher.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; The Ottawa Hospital, Riverside Campus, 1967 Riverside Drive, Ottawa, ON K1H 7W9 Canada.
authors.forename: Ayub
authors.initials: A
authors.lastname: Akbari
authors.affiliation: Department of Medicine, Division of Nephrology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hladunewich
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Burns
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario Canada.
authors.forename: Felipe
authors.initials: F
authors.lastname: Moretti
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada.
authors.forename: Rima Abou
authors.initials: RA
authors.lastname: Arkoub
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Brown
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario Canada ; Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Hiremath
keywords: Chronic kidney disease; Dialysis; Placental growth factor; Pregnancy; Soluble fms-like tyrosine kinase