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Nephrology Fellowship Reviewer > 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
Q

oliguria < 500 ml in 24H, persistent headache or visual disturbance, pulmonary edema, epigastric or ruq, elevated lft and thrombocytopenia alone or in hellp

A

severe preeclampsia

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26
Q

Tx of hus/ttp

A

plasma exchange

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27
Q

tx of hellp and aflp

A

supportive care/delivery

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28
Q

generalized swelling and vacuolization of the endothelial cells and loss of capillary space

A

Glomerular endotheliosis

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29
Q

management: severe preec prior to 24 weeks of gestation

A

termination of pregnancy

30
Q

until when do we withold anti hypertensive therapy for precclampsia

A

bp above 150-160/100-110

31
Q

mgt hellp 24-34 weeks, stable clinical status with reassuring fetal status

A

expectant management

32
Q

history of htn prior to pregnancy or a bp higher than 140/90 prior to 20 weeks

A

chronic hypertension

33
Q

hypertension after 20 weeks and resolves after delivery

A

gestational htn

34
Q

antihypertensive treatment indicated in chronic htn

A

severe hypertension > 160/105

35
Q

first line oral agent

A

methlydopa

36
Q

exception among beta blockers which causes fetal growth restriction

A

atenolol

37
Q

ace and arbs are contraindicated in what trimester

consequences of acei and arbs

A

2nd and 3rd trimester - fetal malformations: renal dysgenesis, perinatal renal failure, oligohyramnios, pulmo hypoplasia, hypocalvaria, iugr

38
Q

antihtn for breastfeeding

A

methlydopa
enalapril/captopril
labetalol/propranolol

39
Q

most common cause of aki during pregnancy

A

hyperemesis gravidarum or vomiting causing prerenal aki

40
Q

severe and often irreversible form of atn associated with septic abortion and placental abruption

A

bilateral cortical necrosis

41
Q

dx of renal cortical necrosis

A

ct scan - hypodense areas in the renal cortex

42
Q

liver failure with elevated serum aminotransferase and hyperbilirubinemia

A

acute fatty liver of pregnancy

43
Q

swollen hepatocytes filled with microvesicular fat and minimal hepatocellular necrosis

A

aflp

44
Q

hemolysis, thrombocytopenia variable organ dysfunction

A

hus - renal failure

ttp - neurologic

45
Q

diagnostic and therapeutic trial intervention to confirm dx of obstructive uropathy if clinical suspicion is high

A

percutaneous nephrostomy

46
Q

majority of stones in pregnancy

A

calcium oxalate and calcium phosphate

47
Q

preferred method to visualize obstruction and stones

A

ultrasound

48
Q

mgt for nephrolithiasis

A

hydration, analgesics, antiemeticw

49
Q

when can eswl be done in pregnancy

A

1st 4-8 weeks

50
Q

nephrolithiasis with uti should be treated with antibx for how long

A

3-5 weeks

51
Q

when is suppresive therapy recommended

A

bacteriuria that persists after 2 courses of therapy

52
Q

suppressive therapy used

A

nitrofurantoin or cephalexin

53
Q

women with sle should postpone pregnancy until lupus activity is quiescent for

A

6 months

54
Q

mmf should be replaced by

A

azathioprine

55
Q

weekly dialysis dose in esrd on hd pregnant patients

A

20 or more hours per week

56
Q

most common complication of pregnancy in transppant recipients

A

hypertension

57
Q

agents of choice from post kt htn

A

methlydopa, labetalol, ccb

58
Q

basis of immunosuppresion during pregnancy for post kt

A

cyclosporine or tacrolimus and steroids

59
Q

dose of steroids and azathioprine considered safe

A

5-10 mg/day

less than 2 mkd

60
Q

mainstay of tx of acute rejection during pregnancy

A

high dose steroid therapy

61
Q

peripheral vasodilation caused by

A

estrogen, progesterone and relaxin

62
Q

relaxes the ureters

A

progesterone

63
Q

primary prevention for preeclampsia in women with high baseline risk

A

aspirin

64
Q

anti htn with tocolytic properties

A

nicardipine

65
Q

mgt of preeclampsia with no severe symptoms

A

postpone delivery
no anti htn unless sbp > 150-160/100-110
MgSo4

66
Q

target Mg in preeclampsia

A

5-9 mg/dL

67
Q

gold standard for gfr measurement

A

Inulin or creatinine clearance

68
Q

hgb target in pregnancy esrd

A

10-11 g/dL

69
Q

normal pregnancy weight gain

A

25-35 lbs

70
Q

with risk for fetal cyanide poisoining

A

nitroprusside

71
Q

when to start aspirin

A

less than 16 weeks to 34-36 weeks

72
Q

hd targets in pregnancy

A

low blood flow 150-250
Low dialysate flow 300
biocompatible dialysis membrane
prehd bun < 50 my/dl or urea < 100 mg/dL

Nephrology Fellowship Reviewer (29 decks)

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