Chronic Kidney Disease Flashcards
What baseline evaluation do you recommend in a pregnant patient with chronic kidney disease?
Serum creatinine. 24 hour urine protein and creatinine clearance
What are maternal risks with chronic kidney disease?
Women with stages 1 and 2 CKD, in general, have successful pregnancies and do not have a worsened renal prognosis.
Stages 3 and above have a increased risk of renal failure within a year of delivery
What are fetal risks with chronic kidney disease?
Preterm delivery
Growth restriction
What factors will increase the risk of adverse pregnancy outcomes in the setting of chronic kidney disease?
Hypertension
Stage 3 and up
What are the most common pregnancy complications in setting of chronic kidney disease?
Hypertension, preeclampsia
Worsening renal failure
Anemia
How do you counsel a patient on the use of ACE-I and ARB in pregnancy?
Decreases efferent arteriole pressure and intraglomerular pressure
How do you counsel a patient on the use of diuretics in pregnancy?
HCTZ is acceptable as second or third line
How do you follow a patient with chronic kidney disease in pregnancy?
Serial 24 hour urine protein and creatinine
Serial serum creatinine
Serial CBC if anemic
What are indications for dialysis?
GFR less than 15
What are maternal and fetal risks for a pregnant patient undergoing dialysis?
Polyhydramnios 33%-62% Maternal hypertension 42%-80% Cesarean section deliveries 46%-53% Preterm delivery 85% Average gestational age at delivery 32 weeks
What are the most common pregnancy complications in pregnant women undergoing dialysis?
Preeclampsia
IUGR
