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Laura MRCOG Part 2 > 9) Maternal Medicine - Renal > Flashcards

9) Maternal Medicine - Renal Flashcards

1
Q

Incidence of AKI

A

1.4% of obstetric admissions

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2
Q

Fall in creatinine in pregnancy

A

35micromol/L (average creatinine 53)

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3
Q

What should be considered diagnostic of kidney injury?

A

New creatinine >90

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4
Q

Most common cause of AKI in pregnancy

A

Pre-eclampsia

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5
Q

Indications for renal replacement therapy

A
  • Metabolic acidosis
  • Hyperkalemia
  • Fluid overload refractory to medical treatment
  • Pregnancy specific: Urea >17 mmol/L*
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6
Q

What percentage of PET leads to AKI?

What percentage of HELLP leads to AKI?

A

PET: 1.5-2%
HELLP: 3-15%

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7
Q

Pathology finding in kidney in PET + HELLP

A

Glomerular endotheliosis (reduces glomerular capillary permeability therefore reducing filtration).

In HELLP, additional thrombotic microangiopathy.

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8
Q

How to adjust dose of MgSO4 in AKI?

A

If urine output <20ml/h or creatinine >90,

50% reduction in infusion rate of MgSO4 (still give bolus) and monitor Mg levels every 4-6h (aiming 2-3.5)

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9
Q

Incidence of thrombotic microangiopathy (TTP/HUS)

A

1 in 25,000

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10
Q

What is the pathology underlying TTP & HUS

A

TTP: ADAMTS13 (levels fall in pregnancy)
HUS: Abnormality in complement activation

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11
Q

What percentage of TTP in pregnancy leads to AKI?

A

30-80%

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12
Q

Incidence of ESRF in HUS

A

75%

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13
Q

When does TTP occur and when does HUS occur?

A

TTP in 2nd/3rd trimester.

HUS postpartum.

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14
Q

Factors distinguishing HELLP from TTP/HUS

A
  • Profoundly low platelets more common TTP/HUS
  • Liver function not usually affected TTP/HUS (except increased bilirubin)
  • AKI more common TTP/HUS
  • Coagulopathy more common HELLP (anti-thrombin and fibrinogen increased in TTP/HUS)
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15
Q

Incidence of AFLP

A

5 per 100,000

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16
Q

Incidence of AKI in AFLP (and percentage requiring renal replacement therapy)

A

14% develop AKI

3.5% require renal replacement

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17
Q

What happens in AFLP?

A

Fetal homozygosity of disorders of beta-fatty acid oxidation leading to excessive fatty acid load in mother.

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18
Q

Kidney biopsy in AFLP

A

Tubular free fatty acid deposition

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19
Q

Things to distinguish AFLP from HELLP

A
  • Low serum glucose
  • Raised serum ammonia
  • Prodromal vomiting
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20
Q

What percentage of cases of SLE have renal involvement?

A

20-50%

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21
Q

What USS finding would suggest pathological renal obstruction?

A

If ureter dilated distal to pelvic brim, if obstruction does not decompress by positioning on all fours and if ureteric jets absent in contralateral position.

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22
Q

Most common cause of acute interstitial nephritis

A

NSAIDs

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23
Q

What percentage of people using NSAIDs develop significant effects or acute renal failure?

A

1-5% side effects

0.5-1% acute renal failure

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24
Q

Incidence of renal transplant

A

2-6 per 10,000 women of childbearing age

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25
Q

Number of pregnancies in women with renal transplants

A

30-40 annually

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26
Q

How long to wait after a renal transplant before conceiving?

A

1 year

27
Q

Risk of acute rejection of renal transplant in first year?

A

10-15%

28
Q

Effect of pregnancy on risk of renal graft rejection

A

If graft function normal then pregnancy doesn’t increase risk of rejection

29
Q

What to switch mycophenolate to in transplant patients and when?

A

Switch to azathioprine and allow 3/12 washout period

30
Q

Hypertension in patients with renal transplant

A
  • 50% have hypertension predating and persisting pregnancy

- 15% new onset in pregnancy

31
Q

GDM in patients with renal transplant

A
  • 5-25%

- Calcineurin inhibitors are diabetogenic

32
Q

What pre pregnancy renal parameter predicts increased rate of loss of maternal renal function?

A

> 1g/day

33
Q

What proportion of people with a renal transplant see their creatinine increase and by what amount?

A

38% see creatinine increase >20%

34
Q

Acute rejection rates for renal transplant during pregnancy

A

2-4%

35
Q

Effect of renal transplant on delivery?

A

Vaginal delivery recommended with continuous CTG

Caesarean rates increased

36
Q

Change in proteinuria in pregnancy in a patient with a transplant

A

Expect to double (and further double if ACEi/AR2 stopped)

37
Q

When do renal transplant patients require VTE prophylaxis?

A

If PCR>300 or ACR>180

38
Q

Effect of renal function on screening tools

A

Reduced urinary bhCG excretion therefore falsely elevated results.

39
Q

How often to monitor renal function and pre-dose tac/ciclosporin levels?

A

At least monthly

40
Q

Risk of injury to kidney at CS

A

1-2%

41
Q

Risk of PET in kidney donors

A

2 x increased risk (should have aspirin prophylaxis!)

42
Q

When does pancreatic transplant usually occur?

A

In conjunction with renal transplant.

43
Q

Rate of adverse outcomes with liver transplant

A

Less than renal

44
Q

Rejection rate with liver transplant

A

10%

45
Q

Rate of adverse outcomes with cardiothoracic transplant

A

Comparable to renal

46
Q

Overall incidence of urinary tract infection in pregnancy

A

8%

47
Q

Definition of asymptomatic bacteriuria

A

> 10^5 bacteria in absence of symptoms

48
Q

Incidence of asymptomatic bacteriuria

A

2-10%

49
Q

What percentage of cases of asymptomatic bacteriuria progress to symptomatic urinary sepsis if untreated?

A

40% (30% cystitis, 50% pyelonephritis)

50
Q

Incidence of symptomatic cystitis

A

2%

51
Q

Incidence of pyelonephritis

A

2%

52
Q

What percentage of cases of pyelonephritis are associated with bacteraemia?

A

15-20%

53
Q

What is the recurrence rate of pyelonephritis?

A

20%

54
Q

Most common organism for UTI

A

E. Coli (second: S. saprophytic)

55
Q

Incidence of recurrent UTI in pregnancy

A

4-5%

56
Q

What treatment for renal stones is contraindicated in pregnancy?

A

Lithotripsy

57
Q

Three severities of CKD

A

Mild: Cr <125
Moderate: Cr 125-250
Severe: Cr >250

58
Q

Effect of pregnancy on renal function in mild CKD

A

2% loss of function

0% permanent deterioration

59
Q

Effect of pregnancy on renal function in moderate CKD

A

40% loss of function
20% permanent deterioration
2% ESRF

60
Q

Effect of pregnancy on renal function in severe CKD

A

70% loss of function
50% permanent deterioration
35% ESRF

61
Q

Pre-eclampsia in CKD

A

20% Mild CKD
40% Moderate CKD
60% Severe CKD
75% Dialysis

62
Q

FGR in CKD

A

25% Mild CKD
40% Moderate CKD
65% Severe CKD
>90% Dialysis

63
Q

PTB in CKD

A

30% Mild CKD
60% Moderate CKD
90% Severe CKD
>90% Dialysis

64
Q

Perinatal mortality with CKD

A

1% Mild CKD
5% Moderate CKD
10% Severe CKD
50% Dialysis

Laura MRCOG Part 2 (56 decks)

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