Renal and Cardiac Decompensation in the Early Postpartum Period in a Woman with Long standing Type 1 Diabetes and Advanced Chronic Kidney Disease: A Case Report

Abstract

Background: Chronic kidney disease (CKD) in pregnant women significantly increases the risk of adverse maternal and fetal outcomes. However, data  are limited regarding the risk of acute postpartum cardiorenal decompensation in women with advanced diabetic nephropathy. We report a case of acute  systolic heart failure and sharp renal deterioration in the early postpartum period in a multiparous woman with insulin dependent type 1 diabetes mellitus (T1DM), stage IV CKD, and longstanding hypertension.

Case: A 31-year-old grand multiparous woman with poorly controlled T1DM, advanced diabetic nephropathy (CKD stage IV), chronic hypertension, proliferative retinopathy, and hypothyroidism delivered prematurely at 33 weeks’ gestation. Two weeks postpartum she presented with acute pulmonary edema, hypertensive emergency, and acute-on-chronic kidney injury (AKI on CKD). Echocardiography showed mildly reduced left ventricular systolic function; cardiac biomarkers were markedly raised. She responded to aggressive diuresis and antihypertensive therapy, with improvement in clinical status. However, she left hospital against medical advice, opting to breastfeed and declining further inpatient management.

Conclusion: This case underscores the complex interplay of diabetic nephropathy, hypertension, and pregnancy-induced hemodynamic stress which may culminate in life-threatening cardiorenal decompensation postpartum. It highlights the need for heightened surveillance, early multidisciplinary management, and comprehensive preconception counseling in women with advanced CKD and diabetes.