Kidney in Pregnancy

Question 1

SVR in Pregnancy

Answer 1

Drops because of relaxin, the CO increases to maintain MAP

Question 2

Natremia

Answer 2

Decreases bc V expansion and new osm setpoint at 270. 140 is abnormal

Question 3

Serum Creatinine

Answer 3

Decreases to .4-.6 due to V expansion/increased GFR

Question 4

Serum Uric Acid

Answer 4

Decreased bc V expansion, if elevated maybe PRA or Pre-Ec

Question 5

Serum Bicarb

Answer 5

Decreases bc respiratory alk comp

Question 6

Proteinuria

Answer 6

Increased to max of 300 bc increased GFR, should still be dipstick neg alb

Question 7

Anemia

Answer 7

Decreased hematocritc bc increased plasma volume

Question 8

Hypercalciuria

Answer 8

Higher risk of stone disease

Question 9

Gestational Diabetes Insipidus

Answer 9

Pregnancies produce vasopressinases, so it’s not nephrogenic

Question 10

2 Teratogenic Immunosuppressive Agents

Answer 10

Mycophenolate and mTOR inhibitors

Calcineurin inhibitors allowed

Question 11

Gestational HTN Criteria (4)

Answer 11

BP 140/90 (either)
No proteinuria
Develops after 20th wk
(Resolves postpartum)

Question 12

Differentiating Factor b/w Gestational HTN and Pre-Eclampsia

Answer 12

Proteinuria > 300 mg (Upr/Ucr > 0.3)

Question 13

Eclampsia

Answer 13

When you get seizures

Question 14

Pathophys of Pre-Ec

Answer 14

Endothelial dysfunction leads to cell swelling and fibrin deposition, causing organ and placental ischemia

Question 15

Pre-Ec Tx (3 things not to do)

Answer 15

Super lowering BP doesn’t help much and can cause fetal growth retardation (just keep below 160/110)
No diuretics bc already V depleted
ACEis/ARB also teratogenic