Kidney in Pregnancy Flashcards
effects of vasodilation
decrease PVR, increase venous compliance, decrease BP, increase RBF
what is the key driving factor in pregnancy
systemic vasodilation drive by
increase in PAAS resistance
increase in NO
two other things taht happen during pregnancy
increase VEGF–>increase angiogensis for placenta
increase plasma volume–>increase CO–>incrase GFR a lot!
because GFR is increasing
decrease in plasma creatinine
increase in urine protein
other things you find in pregnancy
increase in adh–>decrease Na cocnentration
respiratory alkalosis
increase resistance to epo–>rbc volume doesnt cahgen but can be anemic
renal anatomy in pregnancy
increase renal size
increase reflux
lower UT microenvironemtn (increase risk for infx)
–>polyuria and increase risk of infx
healthy placenta makes
VEGF and flt1 which binds and inactivates VEGF in circulation
with HTN and CKD you get
increase arterial compliance
decreased venous capacitance
women in stages 1-3 will
see less of the changes you see in normal progenancy and maybe none if its severe
severe CKD risk
99% for preterm deliery and pre-eclampsia
20-60% risk for preterm delivery and perinatal death
mulitparity and SLE
may increase incidence or worsen renal disease
babies of parents with CKD
have no changes in morphology, just growth (ooften preterm)q
CKD during pregnancy blunts the
decrease in BP
HTN during pregnancy blunts the
increase in GFR
HTN during pregnancy is associated with
abnormal endothelial biology decrease placental perfusion prematurity intrauterine growth retardation preeclampsia
when does pre-eclampsia usually appear?
after 20th week, but could be days- hrs before birth
how does pre-eclampsia work
endothelial activation–>microthrombis in placenta–>decrease vasodilatorsand anticoags–>more thrombi and occlusion
HELLP syndrome
hemolysis
elevated liver function
low platlets
associated with pre-eclampsia
how can you precheck for development of pre-eclampsia
decrease vegf and increase sflt1
rsik factors pre-eclampsia
first or widely spaced pregnancy
extremes of materanl asge
obesity, CKD, HTN, >pregnancy
management of pre-eclampsia
admit, give iv fluids + mg for htn
do NOT ure diuretics for edema (decrease tissue perfusioN)
what meds NOT to use on pregnant people
ACE ARB
okay for pregs
a methyl dopa nifedipine labetolol propanolol hydralazine
