AKI and NSAIDs Flashcards
the causes of AKI in pregnancy
- Preeclampsia
- HELLP syndrome
- acute retention
- placental abruption
- acute fatty live in Pg
- thrombotic microangiopathy (HUS,TTP)
Methods of gestational assessment of renal function
The use of estimated glomerular filtration rate is also not valid in pregnancy, and serum creatinine and change in creatinine are the only parameters that can be used for gestational assessment of renal function.
Serum creatinine in pregnancy
Serum creatinine falls by 35 micromol/l in pregnancy
leading to an average creatinine in pregnancy of 53 micromol/l.
Most common cause of AKI in pregnancy??
PE 1.4%
creatinine value diagnostic for AKI in pregnancy
90 micromol/l
The clinical approach to a pregnant woman with AKI involves:
- fluid status assessment
- medication review
- consideration of fluid replacement
- appropriate diagnostic work-up
- early involvement of a nephrologist for patients who do
not respond to initial management.
Drugs doses reduction in case of AKI
Drug doses may need to be adjusted for a decrease in glomerular filtration rate below 30 ml/minute including antibiotics, anticoagulants, insulin and opiates. The use of NSAIDs, which often form part of a standard postpartum analgesic protocol, is contraindicated in AKI
Which NSAID has best safety profile
Ibuprofen
What is the average creatinine in pregnancy
53 micromol/L
when does NASIDs is contraindicated
- AKI
- 3rd trimester
What is the commenest glomerular disease world wide?
PE
What is the prevalence of pre eclampsia due to AKI
1.5-2%
What findings you will get on renal biopsy in case of pre eclampsia AKI
Renal biopsy reveals endothelial cell swelling, termed glomerular endotheliosis
How we manage the dose of MgSO4 based on creatinine levels
MgSO4 is renally excreted.
if the urine output falls to below 20 ml/hour
or if the creatinine is higher than 90 micromol/l
a 50% dose reduction in magnesium sulphate infusion should be considered from 1 g/hour to 0.5 g/hour.
in severe PE or eclampsia, the usual loading bolus dose of 4 g is given.
in severe PE or eclampsia, the usual loading bolus dose given is
4 g
in severe PE or eclampsia, the usual loading bolus dose given is
4 g
In the context of AKI, how often is the monitoring of the serum magnesium level should be undertaken
every 4 to 6 hours, or whenever there is clinical concern regarding toxicity.
Serum magnesium concentrations advised in AKI
Serum magnesium concentrations may not correlate with toxicity but a level of **2–3.5 mmol/l **is advised.
Women with pre eclampsia should be “kept dry” means
IV hydration:
* isn’t benificial in case of PE w/ oliguria
* in women with PE is associated with pulmonary oedema and increased maternal mortality.
fluid restriction of 80 ml/hour is recommended peripartum.
When the natural diuresis occur in postpartum period
36–48 hours postpartum
Immediate postpartum period what level of urinary output we consider normal .
a urine output >40 ml in 4 hours is sufficient in the immediate postpartum period.
Define HELLP syndrome
a constellation of haemolysis, elevated liver enzymes and low platelets, and is a variant of severe pre- eclampsia.
The incidence of renal impairment in HELLP
3-15%
risk factors of AKI in HELLP
abruption, disseminated intravascular coagulation, sepsis, haemorrhage or intrauterine death
