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Nephrology > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

decrease in svr and increase in arterial compliance is evident by

A

6 weeks of gestation

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2
Q

Plasma volume in pregnancy

A

inc 30-50% above baseline

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3
Q

BP in pregnancy

A

Decrease by 10mmhg below prepregnancy level, nadir in 2nd trimester, gradual inc toward pre pregnancy by term

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4
Q

Cardiac output

A

increase 30-50%

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5
Q

Heart rate

A

increase by 15-20 beats per min

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6
Q

Length of kidney

A

Inc 1-1.5 cm

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7
Q

Renal volume

A

inc up to 30%

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8
Q

renal blood flow

A

increase to 80%

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9
Q

GFR

A

150-200 ml/min, 40-50% baseline

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10
Q

Hgb Crea uric acid pco2 Na Osm

A

decrease

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11
Q

pH Calcium

A

increase

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12
Q

new osmotic setpoint in pregnancy

A

270 mOsn/kg

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13
Q

acid base in pregnancy

A

respi alk

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14
Q

mediates respi alk response

A

Progesterone

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15
Q

hormone central to global vasodilatory response specifically to increase in GFR and rbf

A

relaxin

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16
Q

new onser of hypertension and proteinuria after 20 weeks of gestation

A

preeclampsia

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17
Q

definitive tx of preeclampsia

A

delivery of neonate

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18
Q

criteria for hypertension in pregnancy

A

more than or equal to 140/90 after 20 weeks of gestation on 2 occasions at least 4h apart

more than or equal to 160/105 within minutes

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19
Q

criteria for proteinuria in preeclampsia

A

More than or equal to 300 mg/24H
protein/crea ratio more than 0.3 mg
dipstick +1

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20
Q

Hallmark of preeclampsia

A

proteinuria

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21
Q

in the absence of proteinuria, preeclampsia is still considered in patients with new inset htn with any of the ff

A 
thrombocytopenia 
renal insufficiency 
impaired lft
pulmonary edema 
cerebral of visual symptoms
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22
Q

threshold for thrombocytopenia in preec

A

<100k

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23
Q

criteria for renal insufficiency in preec

A

crea > 1.1 or doubling

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24
Q

sudden inc in woman with chronic htn that was previously controlled or escalation of antihtn to control bp

or

new onset of proteinuria in a whiman with chronic htn or a sudden inc in proteinuria un a woman with known proteinuria before or in early pregnancy

A

superimposed preeclampsia

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25
oliguria < 500 ml in 24H, persistent headache or visual disturbance, pulmonary edema, epigastric or ruq, elevated lft and thrombocytopenia alone or in hellp
severe preeclampsia
26
Tx of hus/ttp
plasma exchange
27
tx of hellp and aflp
supportive care/delivery
28
generalized swelling and vacuolization of the endothelial cells and loss of capillary space
Glomerular endotheliosis
29
management: severe preec prior to 24 weeks of gestation
termination of pregnancy
30
until when do we withold anti hypertensive therapy for precclampsia
bp above 150-160/100-110
31
mgt hellp 24-34 weeks, stable clinical status with reassuring fetal status
expectant management
32
history of htn prior to pregnancy or a bp higher than 140/90 prior to 20 weeks
chronic hypertension
33
hypertension after 20 weeks and resolves after delivery
gestational htn
34
antihypertensive treatment indicated in chronic htn
severe hypertension > 160/105
35
first line oral agent
methlydopa
36
exception among beta blockers which causes fetal growth restriction
atenolol
37
ace and arbs are contraindicated in what trimester | consequences of acei and arbs
2nd and 3rd trimester - fetal malformations: renal dysgenesis, perinatal renal failure, oligohyramnios, pulmo hypoplasia, hypocalvaria, iugr
38
antihtn for breastfeeding
methlydopa enalapril/captopril labetalol/propranolol
39
most common cause of aki during pregnancy
hyperemesis gravidarum or vomiting causing prerenal aki
40
severe and often irreversible form of atn associated with septic abortion and placental abruption
bilateral cortical necrosis
41
dx of renal cortical necrosis
ct scan - hypodense areas in the renal cortex
42
liver failure with elevated serum aminotransferase and hyperbilirubinemia
acute fatty liver of pregnancy
43
swollen hepatocytes filled with microvesicular fat and minimal hepatocellular necrosis
aflp
44
hemolysis, thrombocytopenia variable organ dysfunction
hus - renal failure | ttp - neurologic
45
diagnostic and therapeutic trial intervention to confirm dx of obstructive uropathy if clinical suspicion is high
percutaneous nephrostomy
46
majority of stones in pregnancy
calcium oxalate and calcium phosphate
47
preferred method to visualize obstruction and stones
ultrasound
48
mgt for nephrolithiasis
hydration, analgesics, antiemeticw
49
when can eswl be done in pregnancy
1st 4-8 weeks
50
nephrolithiasis with uti should be treated with antibx for how long
3-5 weeks
51
when is suppresive therapy recommended
bacteriuria that persists after 2 courses of therapy
52
suppressive therapy used
nitrofurantoin or cephalexin
53
women with sle should postpone pregnancy until lupus activity is quiescent for
6 months
54
mmf should be replaced by
azathioprine
55
weekly dialysis dose in esrd on hd pregnant patients
20 or more hours per week
56
most common complication of pregnancy in transppant recipients
hypertension
57
agents of choice from post kt htn
methlydopa, labetalol, ccb
58
basis of immunosuppresion during pregnancy for post kt
cyclosporine or tacrolimus and steroids
59
dose of steroids and azathioprine considered safe
5-10 mg/day | less than 2 mkd
60
mainstay of tx of acute rejection during pregnancy
high dose steroid therapy
61
peripheral vasodilation caused by
estrogen, progesterone and relaxin
62
relaxes the ureters
progesterone
63
primary prevention for preeclampsia in women with high baseline risk
aspirin
64
anti htn with tocolytic properties
nicardipine
65
mgt of preeclampsia with no severe symptoms
postpone delivery no anti htn unless sbp > 150-160/100-110 MgSo4
66
target Mg in preeclampsia
5-9 mg/dL
67
gold standard for gfr measurement
Inulin or creatinine clearance
68
hgb target in pregnancy esrd
10-11 g/dL
69
normal pregnancy weight gain
25-35 lbs
70
with risk for fetal cyanide poisoining
nitroprusside
71
when to start aspirin
less than 16 weeks to 34-36 weeks
72
hd targets in pregnancy
low blood flow 150-250 Low dialysate flow 300 biocompatible dialysis membrane prehd bun < 50 my/dl or urea < 100 mg/dL

Nephrology (28 decks)

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