On the Prognosis of Pregnancy in Patients with One Kidney, with Notes of an Unusually Complicated Case of Labour after Nephrectomy *

IN recent years, owing to the brilliant and rapid advances of surgery, the operation of nephrectomy has become no uncommon procedure for various diseased conditions of the kidney. It follows that we as obstetricians will occasionally be confronted with the question : Should a woman with one kidney be advised to1 mamy and run the risk of becoming a mother? I am assuming, of course, that the remaining kidney is healthy and equal to its duties in ordinary circumstances. W e know that during pregnancy in healthy women the kidneys undergo hypertrophic changes of a strictly physiological character so as to enable them to cope with the increased work they have to do. In the same way, as is well known, the one healthy kidney in the patient whose diseased kidney has been removed undergoes hypertrophy which probably began long before the nephrectomy was performed, the diseased kidney having in all likelihood been more or less functionless for a considerable time prior to 0peration.i If, in such a case, pregnancy should then supervene, further hypertrophy will be required to meet the necessary demands, and as, so to speak, all the patients eggs are now in one basket, any undue strain on this kidney will at once mean very serious renal insufficiency. The case I am about to record shows that in a patient whose remaining kidney is healthy, and has had time to become sufficiently hypertrophied to perform the work of two, the strain of pregnancy can be fairly well borne, for although the patient developed albu-