dialysis and pregnancy Flashcards
Increased risk of miscarriages during what times of prengnacy
before 12 and after 28 weeks
during pregnancy, titrate dialysis according to…
urea
aim to keep under 20
usually 6 sessions per week
give calcium too
in nephrotic syndroe, pre-eclampsia can be harder to diagnose because…
already low platelets. Keep an eye on transaminases and growth retardation
diabetes in pregnancy- how to optimise outcomes?
strict glucose control and ACE 6 months prior to conception, then stop ACE
people who have DONATED a kidney getting pregnant- risks?
Doubling PE risk
increased risk pregnancy associated hypertension, premature birth, diabetes
Aza and pregnancy?
Probably ok- does not cross placenta. category D
Pred and pregnancy?
monitor baby for adrenal insufficiency
Cyc A
no increases in abnormalities or fetal kidney function
does cross placenta
tacrolimus and pregnancy?
lower placental levels
transient high K and renal impairment mild in babies
MMF and pregnancy?
NO
causes congenital abnormalities
monoclonals
can lead to haem abnormalities and predispose to mother CMV
avoid pregnancy for one year after dose
When is SLE a problem in pregnancy?
Dont get preg if active diffuse proliferative GN nephrotic syndrome mod-sev hypertension creatinine over 140 poor cardiopulmonary reserve
when does you lupus flare up?
extra renal T2 T3
renal post partum
How to differentiate renal lupus from pre-eclampsia?
pre-eclampsia hypertension onset after 20 weeks INACTIVE URINE SEDIMENT Uric acid over 5.5 DNA Ab levels neg or stable Complement NORMAL
In lupus flare
- complement 25% decrease
- DS DNA rising titre
- may have rash, arthritis, serositis, fever
- hypertension onset may be before 20 weeks
- ACTIVE URINE SEDIMENT
How long do you want your lupus to be good for before get pregnant?
6 months
