Management Issues

Question 0

Medical management

Answer 0

Tertiary centre
Bloods
Urine culture
Proteinuria (PCR/24 hrs urine collection) every 4 weeks
Anaemia check ( more likely) - blood tx may be required
If not known before pregnancy, biopsy should be done after delivery
Indication for dialyses in pregnancy:
Severe metabolic acidosis
Severe hyperkalaemia
Volume overload leading to congestive heart failure
Pulmonary oedema unresponsive to diuretics

Question 1

Prepregnancy couselling

Answer 1

MDT approach
Outcome depends on degree of renal insufficiency
Risk of PET, IUGR, PTL should be discussed
Risk to pt health and risk of worsening post pregnancy
Single embryo transfer in IVF
change meds such as ACE inhibitors and angiotensin receptor blockers

Question 2

Obstetric management

Answer 2

Early dating scan with usual anomaly screening.
20 week scan should have detail urinary tract scan plus growth scans every 4 weeks
Low dose aspirin
Blood pressure not higher than 140/90
Tx of UTIs and vaginal infections
Agents such as Atosiban should not be used because of uncertainty in patients with renal disease
Delivery should be planned near term if all well
Prophylactic heparin depending on background issue
Post delivery follow up