Clinical Review Interactive case report

A 35 year old woman with diabetic nephropathy who wants a baby: case outcome

BMJ 2004; 329 doi: (Published 14 October 2004) Cite this as: BMJ 2004;329:900
  1. Giorgina Barbara Piccoli (, nephrologist1,
  2. Elisabetta Mezza, nephrologist1,
  3. Giorgio Grassi, diabetologist2,
  4. Manuel Burdese, nephrologist1,
  5. Tullia Todros, associate professor3
  1. 1 Chair of Nephrology, Department of Internal Medicine, University of Turin, Corso Dogliotti, 14-10126 Turin, Italy
  2. 2 Diabetic Care Unit, Department of Internal Medicine, University of Turin
  3. 3 Department of Obstetrics and Gynaecology, University of Turin
  1. Correspondence to: G B Piccoli


    Four weeks ago, we presented the case of Maria Tomasa, who had requested in vitro fertilisation (18 September, p 674). As none of us had any direct experience of assisted conception in patients with overt diabetic nephropathy we searched the literature to determine the risk (25 September, p 729). The data were limited, and after extensively discussing the odds and risks with Tommy on three occasions, we decided to support her decision to have in vitro fertilisation and organised treatment.

    Two embryos were placed and one implanted. Two weeks after the procedure, Tommy developed ovarian hyperstimulation syndrome with ascites. When proteinuria increased to 9 g/day in the third month of pregnancy, she …

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