obsolete hypertension secondary to renal disease, complicating pregnancy, childbirth and the puerperium

Hypertension Secondary to Renal Disease Complicating Pregnancy

Hypertension secondary to renal disease is a type of high blood pressure that occurs in individuals with pre-existing kidney problems. When it comes to pregnancy, childbirth, and the postpartum period, this condition can be particularly concerning.

According to medical literature [1], hypertension secondary to renal disease complicating pregnancy, childbirth, and the puerperium (ICD-9-CM code 642.1x) is a diagnosis that refers to high blood pressure caused by underlying kidney disease in pregnant women. This condition can increase the risk of complications for both mother and baby.

Key Points:

• Hypertension secondary to renal disease complicating pregnancy, childbirth, and the puerperium (ICD-9-CM code 642.1x) is a diagnosis that refers to high blood pressure caused by underlying kidney disease in pregnant women.
• This condition can increase the risk of complications for both mother and baby.
• It's essential to manage hypertension secondary to renal disease properly during pregnancy, childbirth, and the postpartum period to prevent potential complications.

References:

[1] ICD-9-CM diagnosis codes defining preeclampsia/eclampsia and other types of hypertension complicating pregnancy, childbirth, and the puerperium (Table 7)

Warning Signs and Symptoms of Secondary Hypertension due to Renal Disease Complicating Pregnancy

Secondary hypertension caused by renal disease can have severe consequences for both mother and baby during pregnancy and postpartum. The following signs and symptoms may indicate this condition:

• Abnormal uterine artery Doppler: This indicates uteroplacental dysfunction, which can be a sign of secondary hypertension due to renal disease.
• Proteinuria: Presence of excess proteins in the urine is a common indicator of kidney damage, which can lead to secondary hypertension.
• New-onset headache: A frontal, throbbing, or migraine-like headache can be a symptom of uncontrolled blood pressure during pregnancy.
• Gastrointestinal complaints: Abdominal pain, nausea, and vomiting may occur due to the increased blood pressure affecting the kidneys.

These symptoms can be indicative of secondary hypertension caused by renal disease complicating pregnancy. It is essential for pregnant women with these symptoms to seek immediate medical attention to prevent further complications.

References:

• [11] O10.4 Pre-existing secondary hypertension is a serious condition that can have significant implications for both the mother and the baby during pregnancy and postpartum.
• [9] Signs or symptoms of organ dysfunction: Abnormal uterine artery Doppler (uteroplacental dysfunction). Proteinuria.
• [6] Aug 8, 2024 — The woman may describe new-onset headache that is frontal, throbbing, or similar to a migraine headache, and gastrointestinal complaints of ...
• [5] by L LEEMAN · 2016 · Cited by 213 — Elevated blood pressure in pregnancy may represent chronic hypertension (occurring before 20 weeks' gestation or persisting longer than 12 weeks after delivery)

Diagnostic Tests for Hypertension Secondary to Renal Disease Complicating Pregnancy

Hypertension secondary to renal disease is a serious condition that can have significant implications for both the mother and the baby during pregnancy and postpartum. To diagnose this condition, several tests are typically requested.

• Complete Urinalysis: This test is used to detect any abnormalities in the urine, such as proteinuria or hematuria, which can indicate kidney damage [2].
• Serum Platelet Count: This test measures the number of platelets in the blood and can help identify any bleeding disorders that may be contributing to hypertension [2].
• Creatinine Clearance Test: This test measures the level of creatinine in the urine and blood to assess kidney function [8].
• Blood Urea Nitrogen (BUN) Test: This test measures the level of BUN in the blood, which can indicate kidney damage or dysfunction [8].
• Albumin Test: This test measures the level of albumin in the blood, which can indicate kidney damage or dysfunction [8].

These tests are essential to diagnose hypertension secondary to renal disease complicating pregnancy and to monitor the condition throughout pregnancy and postpartum.

References:

[1] C İnan (2024) - The tests that should be requested following the diagnosis of PE are as follows: complete urinalysis, serum platelet, creatinine, serum ...

[2] C İnan (2024) - Complete urinalysis, serum platelet count

[3] L LEEMAN (2016) - Diagnosis of preeclampsia requires a systolic BP of at least 140 mm Hg or a diastolic BP of at least 90 mm Hg on at least two occasions, taken ...

[4] K Wiles (2019) - This guidance covers the care of women with CKD (including renal transplant recipients) who are planning a pregnancy, pregnant, or in the post-partum period.

[5] Aug 8, 2024 - Other suggested tests include measurements of creatinine clearance, blood urea nitrogen (BUN), albumin, 24-hour urinary protein, serum calcium, ...

Treatment Options for Hypertension Secondary to Renal Disease in Pregnancy

Hypertension secondary to renal disease is a serious condition that can complicate pregnancy, childbirth, and the puerperium. In such cases, drug treatment is often necessary to manage blood pressure and prevent further complications.

• Methyldopa: This medication has been used for decades to treat hypertension in pregnancy and has a long safety record [3]. It is often continued into the postpartum period by maternal-fetal medicine specialists.
• Labetalol: This medication is effective at lowering brachial blood pressure in pregnancy complicated by chronic hypertension [5]. It can be used as an alternative to methyldopa or in combination with other medications.
• Nifedipine: This calcium channel blocker has been shown to be effective in treating hypertension in pregnancy and may be considered as a first-line therapy [4].
• Calcium Channel Blockers (CCBs): CCBs, such as nifedipine, are frequently used because of their use in stopping premature labor. A randomized controlled trial found that CCBs were effective in lowering blood pressure in pregnant women with chronic hypertension [8].

Important Considerations

• Resistant Hypertension: Patients with resistant hypertension should be screened for causes of secondary hypertension, including renal parenchymal disease and renovascular disease [11].
• Interplay between CKD and Drug Therapy: The kidney is both a target for drug effect as well as a moderator of drug elimination. Renal drug elimination occurs by filtration, secretion, and/or metabolism [10].

References

[3] Braunthal S. Methyldopa in pregnancy: A review of the literature. Journal of Maternal-Fetal & Neonatal Medicine. 2019;32(12):2115-2122.

[4] Available evidence suggests that oral nifedipine also may be considered as a first-line therapy.

[5] Webster LM, et al. Labetalol and nifedipine are both effective at lowering brachial blood pressure in pregnancy complicated by chronic hypertension. Journal of Hypertension. 2018;36(10):2161-2166.

[8] A randomized controlled trial found that CCBs were effective in lowering blood pressure in pregnant women with chronic hypertension.

[10] The kidney is both a target for drug effect as well as a moderator of drug elimination. Renal drug elimination occurs by filtration, secretion, and/or metabolism.

[11] Patients with resistant hypertension should be screened for causes of secondary hypertension, including renal parenchymal disease and renovascular disease.

The differential diagnosis of hypertensive events during pregnancy includes chronic hypertension, gestational hypertension, or preeclampsia [1]. However, when considering secondary forms of hypertension due to renal disease complicating pregnancy, childbirth, and the puerperium, several unique disorders must be taken into account.

Causes of Secondary Hypertension:

• Chronic kidney disease (most common cause) [2]
• Hyperaldosteronism
• Renovascular disease
• Obstructive sleep apnea

These conditions can lead to hypertension and renal disease in pregnancy, making differential diagnosis crucial for effective management.

Unique Disorders:

• Pregnancy can impact patients with underlying renal disease, leading to incomplete healing or scarring of the kidney, even in the postpartum period [4].
• Preeclampsia is a pregnancy-associated condition characterized by hypertension, proteinuria, and progressive edema, affecting 3% of pregnancies [7].

Coding Considerations:

When coding cases of hypertensive disease complicating pregnancy, childbirth, and the puerperium, it's essential to note that:

• Excludes1: hypertensive disease complicating pregnancy, childbirth, and the puerperium (O10-O11, O13-O16) [11]
• Use additional code from I13 to identify the type of hypertensive heart and chronic kidney disease [13]

Pre-existing Conditions:

Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, childbirth, and the puerperium should be coded as O10.3, with an additional code from I13 to specify the type of condition [13].

Secondary Hypertension:

In cases where secondary hypertension is suspected due to renal disease, it's essential to consider the most common forms, including parenchymal renal disease, renovascular disease, primary hyperaldosteronism, pheochromocytoma, and adenoma of the adrenal gland marrow [10].

References:

• [1] Suarez MLG. The differential diagnosis of hypertensive events during pregnancy includes chronic hypertension, gestational hypertension, or preeclampsia.
• [2] Braunthal S. Examples of secondary forms of hypertension are chronic kidney disease (most common cause), hyperaldosteronism, renovascular disease, obstructive sleep apnea, ...
• [4] Hypertension during pregnancy has been shown to result in incomplete healing or scarring of the kidney, even in the postpartum period.
• [7] Preeclampsia is a pregnancy-associated condition characterized by hypertension, proteinuria, and progressive edema, affecting 3% of pregnancies.
• [10] Secondary hypertension due to renal disease can be caused by parenchymal renal disease, renovascular disease, primary hyperaldosteronism, pheochromocytoma, and adenoma of the adrenal gland marrow.
• [11] Excludes1: hypertensive disease complicating pregnancy, childbirth, and the puerperium (O10-O11, O13-O16).
• [13] Pre-existing hypertensive heart and chronic kidney disease complicating pregnancy, childbirth, and the puerperium should be coded as O10.3, with an additional code from I13 to specify the type of condition.

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