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25 Cards in this Set
- Front
- Back
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Name two reasons/causes for ureteral and renal collecting system dilatation in pregnancy
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1) Progesterone (<14wks) - ureteral relaxation & decreased peristalsis
2) Ureteral compression from gravid uterus |
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What is the upper limit of normal for creatinine in pregnancy?
Is the MDRD equation used to estimate GFR valid in pregnancy? Does it under or overestimate GFR? |
a) 70-75uM
(UTD 70, Williams 75) b) No. Underestimates. |
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In pregnancy maternal glycosuria is abnormal and reflects glucose intolerance or MD
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No - it can be normal for small amounts of glucose to be excreted in the urine due to increased GFR
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Normal pregnancy is a state of maternal:
a) Compensated metabolic acidosis b) Compensated respiratory acidosis c) Compensated metabolic alkalosis d) Compensated respiratory alkalosis |
d) Compensated respiratory alkalosis
(pCO2 = 27-32mmHg) |
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List three reasons why pregnancy predisposes to UTI and upper urinary tract/kidney infection?
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1) Dilation of collecting system - large volume of urine
2) Urinary pooling & stasis 3) Vesicoureteral reflux |
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Give maternal conditions that may predispose to developing pyelonephritis in pregnancy.
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Diabetes
Sickle-cell trait Sickle-cell disease |
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a) At what CFU value should treatment of asymptomatic bacteriuria be recommended?
b) If GBS is cultured from the urine of an asymptomatic pregnant woman, and the CFU is < 10^5 / ml, should she be treated? |
a) >=10^5 (100,000)
b) No (per SOGC guideline - UTD says this is controversial and you can consider treatment) |
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What is the most common presenting symptom of nephrolithiasis?
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Pain (90%)
Hematuria (<=25%) |
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List causes of acute kidney injury/acute renal failure in pregnancy (9).
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Hyperemesis gravidarum
Pre-eclampsia/HELLP syndrome AFLP Sepsis/pyelonephritis TTP-HUS Obstruction (e.g. stone) Worsening pre-pregnancy condition (DM nephropathy, SLE nephritis) Drugs (prescribed and abused) Renal cortical necrosis (abruption, IUFD, AFE) |
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Does having only one kidney (e.g. kidney donor), if it's functioning well, adversely affect pregnancy?
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No.
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List common causes of chronic kidney disease seen in reproductive age women
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Diabetic nephropathy
Hypertension Autoimmune (SLE) Polycystic kidney disease |
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In women with chronic kidney disease, does pregnancy lead to worsening of kidney function and permanent damage?
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Appears to depend on severity of kidney disease going in to pregnancy
mild = Cr < 125uM moderate = Cr 125-265uM severe = Cr >265uM concurrent hypertension is more worrisome generally, Cr > 175uM carries worse prognosis. generally, good outcomes are noted if Cr < 125uM |
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What percentage of women will experience permanent kidney damage/decline in renal function for women with prepregnancy:
a) mild renal disease (Cr < 125uM) b) moderate (125-170uM) renal disease? |
a) <= 10%
b) 40% |
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List adverse maternal, fetal, and pregnancy outcomes in women with moderate-severe chronic kidney disease
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Maternal
mortality (increased) permanent kidney dysfunction - 35% HTN/pre-eclampsia - 50-75% Fetal PTB - 75% FGR - 60% mortality - ~5% |
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Are pregnancy outcomes worse for women on dialysis or women who have received a kidney transplant
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dialysis
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List adverse outcomes associated with women on dialysis through pregnancy
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HTN
Polyhdramnios perinatal death - 15-20% miscarriage - 40% PTB - 25% (32wks) |
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What recommendations can be made for women on dialysis through pregnancy?
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1) Increase frequency (6-7 days / week)
2) Avoid large volume shifts, hypotension, hypoperfusion 3) Avoid hyperuricemia - dialyze to BUN of <=16-17mM 4) Increase dose of EPO to maintain Hb 100-110 5) Carefully monitor nutrition and weight gain |
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With regards to optimal pregnancy timing, what are recommendations for a woman with a kidney transplant?
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Time post-transplant (Williams OB - 2yrs):
1yr after living donor graft 2yr after deceased donor graft Stable kidney function Cr <130uM Urine protein < 500mg / day (or absent) Absence of or easily controlled HTN Drug therapy at maintenance levels |
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Regarding organ transplant medications, which are not safe in pregnancy:
a) Tacrolimus b) Mycophenolate mofetil (Cellcept) c) Sirolimus d) Cyclosporine |
a) safe
b) contraindicated - teratogenic c) contraindicatied - teratogenic d) safe (try to keep dose 2-4mg/kg/d) |
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What are potential neonatal/offspring risks of maternal immunosuppressive therapy in utero?
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Malignancy
Germ cell dysfunction Malformations |
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Outline management points for a women presenting with a history of renal transplantation, preconception, antenatal, and intrapartum.
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1) Stop teratogenic drugs
2) Test/establish stable kidney function Cr <125uM, Urine protein <0.5g/d 3) U/S or MRI to delineate where kidney is and course of the ureter 4) Regular urine cultures 5) q2 week visits until 3T, then weekly 6) Monitor BP closely 7) Monitor for pre-eclampsia closely 8) qMonthly Cr and urine protein 9) Regular q2-4wk fetal U/S for growth 10) Aggressively treat maternal hypertension (<140/90) |
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What potential adverse outcomes should be discussed with pregnant women with a kidney transplant, i.e. what are they at risk for in the pregnancy?
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HTN/pre-eclampsia
PTB Graft rejection (3%) UTI/infection C/S - 50% chance damage to ectopic kidney/ureter |
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Women with what polycystic kidney disease can die of what type of aneurysmal rupture?
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Intracranial berry aneurysm
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What are the characteristic features of nephrotic syndrome?
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Urine protein > 3g/day
Hypoalbuminemia Hyperlipidemia Peripheral edema |
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What medication should be considered for pregnant women with nephrotic range proteinuria?
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Heparin thromboprophylaxis
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