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*Obstetrics - > Renal Disease and Pregnancy (1) > Flashcards

Renal Disease and Pregnancy (1) Flashcards

1
Q

What do we need to remember about when interpreting renal ultrasound in a pregnant woman?

A

Renal calyces and ureters dilate in pregnancy

This is due to high levels of progesterone inducing smooth muscle relaxation throughout the body (so uterus does not contract)

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2
Q

What is symptomatic hydronephrosis in pregnancy?

A

Aching back pain due to backpressure to the kidney -> as ureters are dilated

* normally benign but painful

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3
Q

What happens to renal plasma flow and GFR in pregnancy?

A

GFR and renal plasma flow increase

* this is due to CVSan increase changes e.g. in stroke volume and HR

* happen in early stages of pregnancy

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4
Q

What happens to a urinary protein that is excreted (in pregnancy)?

A

Urinary protein and creatinine excretion will be increased

*this is due to increased renal blood flow and GFR

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5
Q

What is the upper limit of serum creatinine for a woman in the 2nd trimester of the pregnancy?

A

65 umol/l-it falls

* as renal clearance of creatinine is increased (so more creatinine is cleared off - less stays in serum)

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6
Q

What is the upper limit for proteinuria throughout the pregnancy?

A

300 mg/24 hours

* limit is increased due to increased GFR - more protein excreted in the urine

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7
Q

Common disorders of renal system in pregnancy

A
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8
Q

Why is UTI more common in pregnancy?

A

UTI is more common in pregnancy because of physiological dilatation of the upper renal tract -> less peristalsis of ureters -> more opportunity to the bugs to invade(ascend)

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9
Q

Factors that increase risk of UTI in pregnancy

A
  • previous Hx of UTI
  • diabetes
  • steroids
  • immunosuppression
  • polycystic kidneys
  • congenital abnormalities of renal tract
  • neuropathic bladder (e.g. spina bifida, MS)
  • urinary tract calculi
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10
Q

What do we do in terms of UTI screen during antenatal visits?

A

Screen MSU - to look for asymptomatic bacteriuria *

* additional MSU are indicated in pregnancy for those at increased risk of UTI or with symptoms

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11
Q

Clinical features of lower UTI

A

Lower UTI

  • urinary frequency
  • dysuria
  • haematuria
  • proteinuria
  • suprapubic pain
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12
Q

Symptoms suggestive of pyelonephritis

A
  • fever
  • loin/ abdominal pain
  • vomiting
  • rigors
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13
Q

What is seen on urine dipstick

A
  • nitrites
  • leukocyte esterase
  • proteinuria

The dipstick should be followed by MSU (to confirm diagnosis)

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14
Q

What Dx do we consider if proteinuria found on the dipstick in late pregnancy?

A

Always considered pre-eclampsia unless ruled out

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15
Q

What do we consider as significant bacteriuria?

A

> 106 organisms/ml

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16
Q

What if we do MSU culture and there would be non-significant/mixed growth?

A

Repeat with a fresh specimen

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17
Q

Why do we treat bacteriuria in pregnancy?

A

It is to prevent pyelonephritis and preterm delivery

18
Q

How long is a Rx for asymptomatic bacteriuria?

A

3 days for asymptomatic bacteriuria

*but 7 - 10 days for pyelonephritis

19
Q

What do we need to investigate after the Rx of asymptomatic bacteriuria?

A

Regular urine cultures - to make sure we eradicated the bacteria

*2nd course of antibiotics may be required

20
Q

What antibiotics for UTI/ bacteriuria are safe in pregnancy?

A
  • Penicillins (amoxycillin, augmentin), Co-amoxiclav (amoxicillin + clavulanic acid)
  • cephalosporins
21
Q

What antibiotic to avoid in 3rd trimester?

A

Nitrofurantoin - to be avoided in 3rd trimester

*haemolytic actions - baby vulnerable to haemolytic anaemia

22
Q

What antibiotic to avoid in 1st trimester of pregnancy?

A

Trimethoprim

* it is anti-folate drug -> neural tube defects (e.g. spina bifida)

23
Q
A
24
Q

How long is a Rx in pregnancy:

  • acute cystitis
  • pyelonephritis
A
  • acute cystitis -> 7-day course
  • pyelonephrtis -> 10 - 14 days
25
Q

Pyelonephritis + vomiting or pyrexia in a pregnant woman

  • what to do?
A

Admit for IV antibiotics + IV fluids (until apyrexial)

26
Q

What further investigations do we do if a pregnant woman has pyelonephritis or >1 proven UTI?

A
  • check renal function
  • renal USS

* we want to exclude hydronephrosis, congenital abnormalities, calculi)

27
Q

What if a pregnant woman has >1 UTIs + risk factor

A

continuous prophylactic antibiotics

28
Q

What are the commonest causes of renal impairment in women of childbearing age:

A
  • reflux nephropathy
  • diabetes
  • SLE
  • other forms of glomerulonephritis
  • polycystic kidney disease
29
Q

How do we classify renal impairment?

A

mild, moderate or severe -> depends on serum creatinine or GFR

30
Q

What renal disease may first manifest with in a pregnancy?

What further Ix should these signs prompt?

A
  • hypertension
  • proteinuria
  • +/- haematuria

Further Ix: urea and creatinine

31
Q

How reflux nephropathy can lead to renal impairment?

A

Recurrent reflux -> recurrent UTI -> scarring -> renal impairment

32
Q
A
33
Q

Complications of renal disease on pregnancy outcome (3)

A
  • pre-eclampsia
  • prematurity
  • IUGR

*outcome depends on the level of impairment and pre-existing hypertension

*common to all these happen at the same time (as Rx for PE is delivery)

34
Q
A
35
Q

What is a chance of a successful pregnancy in severe renal impairment?

A

<50%

Due to frequent severe pre-eclampsia + IGUR

36
Q

What should we counsel a woman in terms of pregnancy if she’s got a severe renal impairment?

A

Counsel against pregnancy/delay until she had a kidney transplant

*due to risk of bad outcomes for mum and baby

37
Q

What can happen (apart from PE, IGUR, premature birth) in a pregnancy if a woman has a severe renal impairment?

A

Development of polyhydramnios -> leading to cord prolapse

*this results from foetal polyuria in response from high osmotic load from increased maternal urea

38
Q

What high urea in a women does to fertility?

A

High urea = embryotoxic - woman unlikely to get pregnant

*if get pregnant there is a high chance of spontaneous miscarriage

39
Q

Why does polyhydramnios develop in a woman with severe renal impairment?

A

this results from foetal polyuria in response from high osmotic load from increased maternal urea

40
Q

What complications are associated with nephrotic syndrome + heavy proteinuria

A
  • worsening hypo-albuminaemia
  • risks of pulmonary oedema and thrombosis

*Obstetrics - (36 decks)

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