Pregnancy

Question 1

microhematuria in pregnancy causes and Ix?

Answer 1

UTI: urine C/ST
stone, PCKD, CA: USG kidney
LN: ANA
IgAN: renal biopsy

if no proteinuria can defer Ix 3m postpartum

Question 2

proteinuria in pregnancy def?

Answer 2

> 0.3g/d proteinuria

Question 3

proteinuria in pregnancy cause and Ix?

Answer 3

defer most Ix postpartum unless NS / AKI < 24wks

Question 4

asymptomatic bacteriuria Tx?

Answer 4

cefalexin, Augmentin, nitrofurantoin x 7 days

prophylactic cefalexin 250mg nocte if persistent

Question 5

HT in preg def?

Answer 5

BP > 140 / 90

Question 6

gestational HT def?

Answer 6

new onset HT after 20wks gest without EOD persist till 12wks postpartum

Question 7

preeclampsia def?

Answer 7

de novo HT after 20wks with 1 or more of:

• proteinuria > 0.3g/d
• organ dysfunction
• • Cr > 90
• • ALT 2x ULN +/- RUQ pain
• • Neuro: clampsia, altered mental status, blind, stroke, hyperreflexia with clonus, headache with hyperreflexia, visual scotoma
• • haemat: plt < 150, DIC, hemolysis
• • uteroplacental: IUGR

Other features: APO

Question 8

Risk factors for preclampsia?

Answer 8

maternal: nulliparity, multiple gestation preg, Hx of preeclampsia, previous IUGR, previous aruptio, ART, molar, trisomy 13, GDM
Obstetric paternal: father from preclampsia pregnancy, FHX of preclampsia
Maternal comorbid: HT, CKD, DM, obesity, APS, SLE, PCOS
Genetic: thrombophilia, preeclampsia in 1st degree relative
Other: age > 40, SGA, pregnancy interval > 10 years

Question 9

uric acid ref range in pregnancy?

Answer 9

< 32wks: 0.24

> 38wks: 0.33

Question 10

Ix for preeclampsia?

Answer 10

uPCR, CBC, RFT, urate, LFT, USG fetal

Question 11

HELLP def?

Answer 11

MAHA: schistocyte, high bili, high LDH, low hapto
high ALT
low plt

Question 12

preelampsia mgt?

Answer 12

Aspirin at 12-14wks and end 37 wks for high risk woman (ASPRE trial)
Ca supp (1.5-2g/d) if high risk and low Ca intake
Anti HT if > 160 / 100 (consider also if lower), use labetalol 50mg IV Q20min, methyldopa, hydralazine 5mg IV bolus Q30min or infusion 5-10mg/h, nifedipine 10mg PO, prazosin
steroid if < 34 wks
MgSO4 4g over 15min followed by infusion 1-2g/h if neuro sign

Question 13

indication of delivery in preclampsia?

Answer 13

progressive MOD: worsening RFT, LFT, Plt, develop neuro sign
refractory high BP
failure of fetal growth
gest > 37 wks

Question 14

Target BP in pregnancy?

Answer 14

CHIPS: 140 / 85

Question 15

AFLP cause?

Answer 15

AR genetic error in long chain 3 hydroxyacyl CoA dehydrogenase (LCHAD)

Question 16

AFLP features?

Answer 16

fever, epigastric pain, vomiting, jaundice, preeclampsia like, high bili and ALT, WCC high, hypoglycemia, coagulopathy

Question 17

AFLP Tx?

Answer 17

reverse coagulopathy, IVF, prompt delivery

Question 18

TMA in pregnancy ddx?

Answer 18

HELLP, HUS, TTP

Question 19

diff HELLP and HUS / TTP and preeclampsia?

Answer 19

clotting and LFT usually normal in HUS / TTP
high ratio of LDH to AST (25:1) indicate HUS
prominent MAHA and low plt and dLFT in HELLP than preeclampsia

Question 20

TTP / HUS in pregnancy Tx?

Answer 20

TTP: TPE
HUS: supportive, eculizumab

Question 21

AKI in pregnancy def?

Answer 21

Cr > 90 or increase of 44 in 48hr

Question 22

AKI in pregnancy causes?

Answer 22

prerenal:
- APH / PPH
- hyperemesis gravidarum
- amniotic fluid embolism
- sepsis
Renal:
- ATN
- pyelonephritis
- cortical necrosis
- TMA
- preeclampsia
- HELLP
- AFLP
- GN
- Drug
post renal:
- obstructive
- calculi

Question 23

When start RRT in pregnancy?

Answer 23

Urea > 15