Renal Disorders Flashcards
(26 cards)
What are the renal system changes in pregnancy?
-Increase in kidney volume
-Dilatation of ureters and renal calyces
-Increased renal blood flow
-Increase in glomerular filtration rate
-Oedema in 35-85% of healthy pregnant women
-Decreased tone and increased capacity of bladder
-Pressure from enlarging uterus and displacement of bladder.
-Decrease om the half life of drugs cleared by the kidney.
What is a urinary tract infection?
An infection of the bladder (cystitis), urethra (urethritis) or kidneys (kidney infection).
What are UTI’s caused by? (aetiology)
Caused by bacteria in the urinary tract (usually originating from the bowel)
Bacteria attaches to the urethral mucosal epithelial cells and will then travel to the bladder via the urethra.
Why are UTI’s more common in pregnancy? (Habak and Griggs, 2020)
Relaxing the smooth muscle of the ureters
Ureters increase in diameter during pregnancy
Ineffective voiding due to the gravid uterus
Bladder distension throughout childbearing continuum
Catheterisation in labour
Immunocomprised nature of pregnancy itself.
What are the symptoms of UTI’s?
Increased frequency of micturition
Dysuria (not being able to urinate/or pain)
Nocturia (Needing to urinate at night)
Offensive smelling urine
Haematuria (Blood urine)
Suprapubic discomfort
Malaise
What are the complications of UTI’s in pregnancy?
GBS bacteriuria
Pre Term labour (If the bladder is irritated it can rub the uterus and start cramping.)
LBW
Pyelonephritis (Kidney Infection)
Sepsis
What is a definition of pyelonephritis?
A bacterial infection causing inflammation of the kidneys.
What is the aetiology of pyelonephritis?
A complication of an ascending UTI which spreads from the bladder to the kidneys.
What is the increased risk of pyelonephritis?
Of pre-term birth/ LBW
What may acute pyelonephritis present with?
Pyrexia
Rigors-Shakes
Abdominal/flank pain- lower back
Nausea and vomiting
What is the management of UTI’s/pyelonephritis in pregnancy?
Urinalysis via dipstick
Confirmed through lab culture- clean catch (MSU)
Prompt treatment
Appropriate ABX
Pyelonephritis- hospitalise; IV ABX; IV hydration; analgesia; obs; fluid balance
What is the management of UTIs/pyelonephritis in labour?
?CTG if maternal tachycardia/ pyrexia
Encourage regular bladder emptying
Hygiene
Avoid catheterisation
Ensure adequate hydration
What is the management of UTIs/pyelonephritis postnatally?
? renal USS for baby if maternal reflux nephropathy
Encourage fluids
Appropriate ABX
What is the definition of chronic kidney disease? NICE, 2024
CKD is defined as a reduction in kidney function or structural damage (or both) present for more than 3 months, with associated health implications
What are the causes of CKD
Diabetes
Hypertension
Infection
Genetic condition i.e. horse shoe kidney
Damage from medications e.g. lithium, omeprazole, NSAIDs
What are the complications in pregnancy of CKD?
Hypertension/PET
Fluid retention
Anaemia (Kidney’s aren’t giving signals to the bone marrow to make more RBC)
Proteinuria (Proteins arent filtered out)
Deteriorating renal function
IUGR
Pre-term birth
Fetal loss.
What is the management of CKD in pregnancy?
75mg OD aspirin
Regular blood tests to monitor renal function
BP monitoring
Med review
Regular fetal growth USS
Baseline U&E and LFT with booking bloods
Monthly MSU
What is the management of CKD in labour?
Careful monitoring of BP and renal function
Strict fluid balance
Monitor fetal wellbeing
Consider omitting ergometrine
What is the management of CKD Postnatally
Careful monitoring of BP and renal function
baby renal USS if cause is genetic
Medication review
Ensure hydration
What is the definition of Acute kidney injury (NICE, 2023)
AKI is a term covering a spectrum of injury to the kidneys that can result from a number of causes
It is characterised by a sudden decline in renal function over hours or days that can result in failure to maintain fluid, electrolyte, and acid- base balance.
What are the symptoms of AKI?
Nausea and vomiting, diarrhoea or suspected dehydration
Reduced urine output or changes to urine colour
Confusion, fatigue or drowsiness.
What are the causes of AKI?
Hyperemesis
UTI/Pyelonephritis
Placental abruption
Haemorrhage
PET, HELLP (Cause the kidneys control BP)
Acute fatty liver (Fatty dispositions in liver, impairing function)
NSAIDs
How is AKI diagnosed?
At risk group
U&Es- changes in serum creatinine levels
Urinalysis
A decrease in urine output
What is the management of UKI?
Hospitalise
Manage underlying cause
Fluid balance
?dialysis
Expedite birth.
