278 Med Arh. 2012 Aug; 66(4): 278-280 • CASE REPORT Successful Pregnancy and Delivery After Kidney Transplantation DOI: 10.5455/medarh.2012.66.278-280 Med Arh. 2012 Aug; 66(4): 278-280 Received: March 15th 2012 Accepted: June 20th 2012 CONFLICT OF INTEREST: NONE DECLARED CASE REPORT Successful Pregnancy and Delivery After Kidney Transplantation Zana Zegarac 1 , Zeljko Duic 1 , Sandra Stasenko 1 , Vanja Fenzl 1 , Jasenka Zmijanac-Partl 1 , Mladen Knotek 2 Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia 1 Department of Internal Medicine, Merkur University Hospital, Zagreb, Croatia 2 T he kidney transplantation is considered to be the best therapy for terminal kidney disease, nowadays. Numerous studies have shown that pregnancy may be successful and may result in a delivery of a healthy baby after the kidney transplantation. Pregnant women who are the recipients of a kidney transplant have increased chances of developing hypertension, preeclampsia, as well as going into premature labour and frequently giving birth to newborns of low birth weight. We present a case of a successful pregnancy and delivery in a 32-year-old kidney transplant recipient who conceived spontaneously four years posttransplantation. e kidney transplantation has been done due to the chronic hypertension and the consequential kidney atrophy. During the pregnancy, the patient underwent anti- hypertension and immunosupressive drugs therapy. She was also being monitored by the gynaecologist and the nephrologist. e pregnancy was terminated in the 40 th week by an urgent Caesarean section due to the fetal bradycardia. e patient gave birth to the healthy baby girl. Key words: Pregnancy, Kidney transplantation, Chronic kidney disease, Immunosupresive drug. Corresponding author: Zana Zegarac, MD. Merkur University Hospital, Zajceva 19, 10000 Zagreb Croatia, E-mail address: zanazegarac@yahoo.com 1. INTRODUCTION Chronic renal failure is often as- sociated with infertility/sterility. e first successful pregnancy in women with transplanted kidney is described in 1963. Pregnancy in a woman with a transplanted kidney due to the great progress of surgical techniques and im- munosuppressive drugs, can be success- ful today, even though there is a pos- sibility of complications both for the mother and the fetus (1). 2. CASE REPORT e patient was born in 1979. Since the age of 14 has suffered from hyper- tension. At the age of 27, due to the atro- phy of kidney, she underwent the trans- plantation of her father’s kidney. ree years later, she spontaneously conceived and miscarried in the first trimester of pregnancy. Spontaneously conceived again after one year. e course of preg- nancy was normal with regular ambula- tory control at the nephrologist and gy- necologist. In the 35 th week, she was ad- mitted to our hospital for treatment and supervision. For immunosuppression she was taking tacrolimus 3,0,2.5 mg and azathioprine 50 mg 3x1 tbl. For the blood pressure control she was taking diltiazem 60 mg 2x1 tbl and bisopro- lol-fumarate 1.25 mg 1 tbl. e blood pressure values were less than 140/90 mmHg. e laboratory values of urea, creatinine, protein in 24-hour urine col- lection and creatinine clearance were within normal values. e OGTT with 75 g of glucose: 0 minutes = 4.6 mmol/L, 120 minutes = 4.9 mmol/L. Urine cul- tures were sterile. Serological testing for TORCH was negative. e concen- trations of tacrolimus in the blood were measured twice a week and the nephrol- ogist corrected the dose twice (3, 0, 3 mg and 4, 0, 4 mg). e ultrasound ex- amination of the fetus was normal, with normal fetal growth and development appropriate for the age. Spontaneous childbirth began with regular labours in the 40th week of pregnancy. Child- birth by C-section due to the fetal bra- dycardia. A female child was born, 2880 g/49 cm, apgar scora 8/9. e patient was released on the 7th postoperative day. Bromocriptine was introduced for the purpose of ablactation. 3. DISCUSSION Terminal renal disease changes the function of the hypothalamus-pi- tuitary-ovarian axis, which can affect the menstrual cycle (amenorrhea, oli- gomenorrhea, anovulation) and cause infertility. e increased concentration of prolactin, FSH and LH is common in patients with terminal renal disease. Disorder of the menstrual cycle (from oligomenorrhea to amenorrhea) was noticed in 74% of patients with termi-