Renal And Urinary System

Question 1

How does the glomerular filtration rate increase

Answer 1

Increases by 40-50%
Progesterone and relaxin cause vasodilation increasing blood flow to the glomerulus

Question 2

What does increased GFR lead to

Answer 2

Reduces levels of creatinine, urea and Uris acid in the blood
Needed to handle the increased production of Uris acid by the placenta and fetus

Question 3

How does blood pressure change in pregnancy

Answer 3

Low blood pressure

Question 4

What happens if systolic BP falls below 80mmHg

Answer 4

Autoregulation fails which impairs the kidney’s ability to filter
Damage may or may not be reversible

Question 5

What does high blood pressure cause during pregnancy

Answer 5

Hypertension can cause or result of renal disease
Disrupts renal function if renal blood vessel damage causes ischaemia
Reduced blood flow stimulates the renin-angiotensin-aldosterone system, raising blood pressure further

Question 6

How does selective reabsorption change in pregnancy

Answer 6

Increasing progesterone increases GFR, reduces vascular resistance
Increasing relaxin causes vasodilation increasing ADH
increasing hCG increases ADH and blood volume and decreases plasma sodium

Question 7

How is selective reabsorption changes apply to practice

Answer 7

Polydipsia: excessive thirst
Polyuria: excessive urination more than 3l a day
Increase in thirst and urination may be a sign of gestational diabetes

Question 8

Describe proteinuria in pregnancy

Answer 8

Proteinuria: urinary protein increases, more than 300mg in 24hrs
Increased GFR, increased permeability so impaired reabsorption in the tubule so protein passes through and not reabsorbed

Question 9

What are the signs of pre-ecamplsia

Answer 9

Proteinuria and raised BP

Question 10

Describe haematuria

Answer 10

Red blood cells present in urine, indicator of kidneys may be impaired as larger cells made their way through the membrane

Question 11

Describe glycosuria

Answer 11

In pregnancy glucose reabsorption is less effective so may exceed reabsorption capacity
Glucose can be present in urine

Question 12

Describe ketonuria

Answer 12

Presence of ketones in urine
Suggestive of fat being metabolised rather than carbs

Question 13

Describe the change of ureters due to progesterone and relaxin

Answer 13

Progesterone and relaxin relax smooth muscle and reduce peristalsis in the ureters, may cause kinking of ureters which can hinder the flow of urine

Question 14

Describe the other changes to the ureters

Answer 14

The gravid uterus compresses the ureters
Reducing urine flow from kidneys to bladder
Increased urinary stasis (stationary urine, increases risk of infection)

Question 15

Describe hydronphrosis

Answer 15

Mild hydronephrosis is: swelling of kidney due to build up in urine results from compression of ureters and effects of progesterone on reducing the tone of ureters

Question 16

Describe the urinary bladder changes in pregnancy

Answer 16

Capacity of the bladder increases under the influence of progesterone
Growing uterus comprises bladder capacity so may report increased frequency of micturition