13. Pregnancy and kidney diseases. Urinary tract infections Flashcards
causes of Acute kidney injury (AKI) in pregnancy
May develop on the basis of chronic kidney disease, or secondary to pregnancy complications (preeclampsia, HELLP syndrome, DIC).
Consider prerenal, intrinsic renal, and postrenal causes.
what is the general management of AKI during pregnancy?
identify the etiologic factor and treat appropriately
what is the general management of CKI during pregnancy?
serial and careful monitoring of serum creatinine, urea, proteinuria, electrolytes, and BP. Avoidance of precipitating factors (fluid imbalance).
can pregnancy be considered after renal transplant?
only 1-2 years after transplant, with close monitoring by a nephrologist, and careful measurement of renal function.
Pregnancy after renal transplantation is classified as a very high-risk pregnancy
Common etiologies of CKI in reproductive-age women ?
Lupus nephritis
diabetic nephropathy
Chronic kidney disease in pregnancy?
high risk for both maternal and fetal morbidity and mortality
why is pregnancy associated with an increased risk for UTI ?
secondary to obstructive uropathy, ureter dilation (stasis), and glucosuria.
antibiotics Contraindicated during pregnancy?
TMP-SMX, fluoroquinolones.
when is asymptomatic screening for UTI?
first prenatal visit or 3rd trimester visit
what is the management for cystitis or asymptomatic bacteriuria?
- PO antibiotics (amoxicillin, nitrofurantoin, fosfomycin)
- Repeat urinalysis after treatment completion
what indicates a pregnant women has pyelonephritis
+ Urinalysis
+ Symptoms
Patient is toxic (fever, WBC ↑,CostoVertebral Angle tenderness)
management of pyelonephritis in pregnancy
- admit to hospital
- IV ceftriaxone
no improvement–> consider renal abscess (check with US, drain surgically if positive)
improvement–> change to PO antibiotics (complete 10 days course)
In a pregnant patient with ≥ 3 consecutive positive urine cultures?
initiate daily suppression therapy
