Kidney disease in pregnancy

Question 1

What is the risk of pre-eclampsia in a woman with hypertension?

Answer 1

25% risk

Question 2

Proteinuria increases risk for pre-eclampsia. True/False

Answer 2

False, but it results in poor outcome for the foetus. Concurrent elevated dBP and proteinuria is the greatest risk for poor foetal outcomes.

Question 3

Control of BP in pregnancy results in reduced risk of pre-eclampsia. True/False

Answer 3

False; the only shown benefit is a reduction in severe hypertension

Question 4

There is no risk associated with CKD Stage 1 in pregnancy. True/False

Answer 4

False

Increases risk of IUGR, NICU admission, C-section, pre-eclampsia

Question 5

The risk of foetal demise is higher among women who have donated one of their kidneys. True/False

Answer 5

True

Question 6

Past history of AKI, regardless of normal current function, is predictive of pre-eclampsia. True/False

Answer 6

True

Question 7

What is the most common cause of nephrotic syndrome in women world-wide?

Answer 7

Pre-eclampsia

Question 8

How long (in general) should you wait before becoming concerned about proteinuria post-partum?

Answer 8

3 months (in general), but time to resolution is dependent on the degree of proteinuria.

Question 9

At what gestation does pre-eclampsia tend to first occur?

Answer 9

20 weeks GA

Question 10

What is the most common cause for AKI (by mechanism) in the peripartum and postpartum period?

Answer 10

TMA

Question 11

Genetic defects in the complement system leading to aHUS typically affect what factor?

Answer 11

Factor H

Question 12

ACEi are safe in breast feeding women. True/False

Answer 12

True

Question 13

What percentage of pregnancies in transplant patients result in live births?

Answer 13

75-85%

Question 14

What is the median gestational age that transplant patients achieve?

Answer 14

35 weeks

Question 15

How long after transplant should a patient wait before becoming pregnant?

Answer 15

1-2 years

Question 16

What is the main differentiating factor between TTP and C-TMA in pregnancy?

Answer 16

The time to onset.

TTP generally occurs in the second and third trimesters whereas C-TMA occurs post partum

Question 17

What is the pathogenesis of acute fatty liver of pregnancy?

Answer 17

It occurs secondary to an autosomal recessive genetic error that results in defective long-chain 3 hydroxy acyl CoA dehydrogenase. This leads to abnormal fatty acid oxidation in mitochondria. The excess in fatty acids spills into the maternal circulation from the foetal circulation. This causes the liver injury.

Question 18

Talk a little bit about delivery in pre-eclampsia

Answer 18

You should deliver women with pre-eclampsia once they have reached 37 weeks, but the name of the game is to prolong the pregnancy as long as is possible without jeopardising maternal or fetal well being.

Question 19

At what level of hypertension is antihypertensive treatment recommended in pre-eclampsia?

Answer 19

All patients with blood pressure >160/100

Question 20

What is given as seizure prophylaxis in severe hypertension in pregnancy?

Answer 20

IV MgSo4 4g over 15 mins then 1-2g per hour