Kidney in Pregnancy

Question 0

effects of vasodilation

Answer 0

decrease PVR, increase venous compliance, decrease BP, increase RBF

Question 1

what is the key driving factor in pregnancy

Answer 1

systemic vasodilation drive by
increase in PAAS resistance
increase in NO

Question 2

two other things taht happen during pregnancy

Answer 2

increase VEGF–>increase angiogensis for placenta

increase plasma volume–>increase CO–>incrase GFR a lot!

Question 3

because GFR is increasing

Answer 3

decrease in plasma creatinine

increase in urine protein

Question 4

other things you find in pregnancy

Answer 4

increase in adh–>decrease Na cocnentration
respiratory alkalosis
increase resistance to epo–>rbc volume doesnt cahgen but can be anemic

Question 5

renal anatomy in pregnancy

Answer 5

increase renal size
increase reflux
lower UT microenvironemtn (increase risk for infx)
–>polyuria and increase risk of infx

Question 6

healthy placenta makes

Answer 6

VEGF and flt1 which binds and inactivates VEGF in circulation

Question 7

with HTN and CKD you get

Answer 7

increase arterial compliance

decreased venous capacitance

Question 8

women in stages 1-3 will

Answer 8

see less of the changes you see in normal progenancy and maybe none if its severe

Question 9

severe CKD risk

Answer 9

99% for preterm deliery and pre-eclampsia

20-60% risk for preterm delivery and perinatal death

Question 10

mulitparity and SLE

Answer 10

may increase incidence or worsen renal disease

Question 11

babies of parents with CKD

Answer 11

have no changes in morphology, just growth (ooften preterm)q

Question 12

CKD during pregnancy blunts the

Answer 12

decrease in BP

Question 13

HTN during pregnancy blunts the

Answer 13

increase in GFR

Question 14

HTN during pregnancy is associated with

Answer 14

abnormal endothelial biology
decrease placental perfusion
prematurity
intrauterine growth retardation
preeclampsia

Question 15

when does pre-eclampsia usually appear?

Answer 15

after 20th week, but could be days- hrs before birth

Question 16

how does pre-eclampsia work

Answer 16

endothelial activation–>microthrombis in placenta–>decrease vasodilatorsand anticoags–>more thrombi and occlusion

Question 17

HELLP syndrome

Answer 17

hemolysis
elevated liver function
low platlets
associated with pre-eclampsia

Question 18

how can you precheck for development of pre-eclampsia

Answer 18

decrease vegf and increase sflt1

Question 19

rsik factors pre-eclampsia

Answer 19

first or widely spaced pregnancy
extremes of materanl asge
obesity, CKD, HTN, >pregnancy

Question 20

management of pre-eclampsia

Answer 20

admit, give iv fluids + mg for htn

do NOT ure diuretics for edema (decrease tissue perfusioN)

Question 21

what meds NOT to use on pregnant people

Answer 21

ACE ARB

Question 22

okay for pregs

Answer 22

a methyl
dopa
nifedipine
labetolol
propanolol
hydralazine