Pregnancy and Kidney Disease (7/19) (done) Flashcards
Normal BP changes in pregnancy?
What happens to the SVR and why?
What happens to CO?
What happens to Cre?
(figure)
Fall in BP
Decrease in SVR: refractory of ang II, increased NO and relaxin
Increase in cardiac output
SCre drops a little (~0.5)
What kind of AB DO in normal pregnancy?
Hormone responsible?
Resp Alk
What is the BP cutoff to treat in pregnancy?
Normal cutoff: >140/90
Severe: Treat is BP >159/99
OR end organ damage
risk of placental hypoperfusion
(i dont know if this is a good question, because other guidemlines are lower at 140/90 - maybe you dont treat this though)
What are the best HTN meds in preg?
Alpha blocker? Beta blocker? CCB? Diuretics? Other?
What medication do we try to avoid due to cyanide content in pregancy?
Avoid nitroprusside
When should you use nitroglycerin infusion?
Magnesium?
Nitro when there is pulmonary edema
Mag is used to prevent eclampsia
What is your management in HTN emergencies in pregnancy?
What are some common causes of ATN?
What are some common pre-renal causes of AKI?
(figure)
What are some common intrinsic causes for AKI?
(figure)
What is acute cortical necrosis? What are some pregnancy related causes?
(figure)
What are 5 pregnancy disorders that can give you TMA?
Dx criteria for pre-eclampsia?
(figure)
new criteria when there is no proteinuria (ACOG 2013)
What are some preventative measures to provide against preeclampsia?
Calcium and low dose ASA
Whats the treatment for preeclampsia? What’s the cure
magnesium sulfate
Delivery is the cure (remove the placenta)
effective in preventing initial and recurrent seizures, and lowers maternal morality
When does PEC/eclampsia occur? Pre, peri, or post-partum?
Can occur anytime, even post partum
Hyperbili, high NH3, hypoglycemia, liver failure, increased liver enzymes
What is the condition?
When is promp termination of pregnancy warranted?
Acute fatty liver of pregnancy (with LCHAD deficiency)
TTP/HUS figures
Can you give eculizumab in pregnancy?
Yes, you can give eculizumab in pregnancy
What are some maternal and fetal complication of SLE?
(figure)
When do you biopsy in pregnancy?
You don’t.
When do you stop hydroxychloroquine during pregnancy?
You don’t.
Lupus nephritis can look like HELLP, but here the liver is spared
AKI in pregnancy
(figure)
Preffered abx in pregnancy
(figure)
AKI timing in pregnancy
(figure)
DM nephropathy increases your risk of what during pregnancy?
ADPKD and pregnancy
(figure)
Meds that are safe in pregnancy
(figure)
When to start HD in pregnancy?
BUN goals?
Anemia management/treatment? MBD management/treatment?
(figure)
Pregnant transplant patients are at a higher risk of what?
PEC, preterm birth, low birth weight, c-section
What IS meds should you avoid?
MMF and cyclophos
mTORs as well (limited data)
Stop all at least 12wks prior to conception
mTORs: impaired spermatogenesis
Normal physiology of pregnancy
(figure)
HTN treatment in pregnancy
(figure)
AKI in pregnancy
(figure)
CKD in pregnancy
(figure)
GN/HD/Transplant in pregnancy
(figure)
