Intrahepatic cholestasis of pregnancy in a chronic kidney disease patient: A case report

The pregnancy-specific liver condition known as intrahepatic cholestasis of pregnancy (ICP) is characterized by pruritus throughout the third trimester of pregnancy and elevated serum transaminases. ICP in patients with CKD can obscure the diagnosis. Fetal risks whose mothers suffer from ICP must be monitored. Case: 32-year-old woman 29 weeks pregnant with a history of CKD and routine hemodialysis, complaints of itching appeared on the palms and legs that extended into the abdomen and back in the final trimester of pregnancy. The serum transaminase results are within normal limits. Topical emollients are given as therapy. Babies are born prematurely with low birth weight and asphyxia. The baby dies at the age of 3 days. The patient's itching complaints are reduced after delivery. Discussion: The diagnosis of ICP is based on pruritus complaints on both palms and feet in late trimester pregnancy. Increased serum aminotransferase levels are a clue to the diagnosis. Normal serum aminotransferase is due to a deficiency in its coenzyme formation due to CKD. ICP therapy is non-specific and systemic. Increased levels of maternal bile acids cause the failure of pulmonary surfactant and increase oxytocin resulting in premature labor. Chorionic venous vasoconstriction and placental oxidative stress cause low birth weight in infants. Conclusion: Pruritus with or without skin changes in the last trimester of pregnancy should consider the possibility of ICP. CKD patients have normal or lower serum aminotransferase levels. Strict supervision of the fetus should carried out. © 2023 Pakistan Association of Dermatologists. All rights reserved.