Ruptured ectopic pregnancy with chronic kidney disease with acute on chronic anaemia - anaesthetic challenges: a case report

Chronic Kidney Disease (CKD) results in progressive and irreversible reduction in Glomerular Filteration Rate (GFR). Pregnancy in CKD patients have poor outcomes both for the mother and the fetus. Patients with CKD have a tendency to develop oedema and congestive cardiac failure or may become severely volume depleted when salt and water intake is decreased. The renal function deteriorates and hypertension can worsen leading to preeclampsia or eclampsia. Physiological anemia of pregnancy may worsen with CKD. Major anaesthetic challenges include cautious fluid management and pressure and volume overload, avoiding nephrotoxic drugs, electrolyte and acid base balance and good quality intraoperative and post operative pain management.