Pregnancy and Kidney Disease (7/19) (done)

Question 1

Normal BP changes in pregnancy?
What happens to the SVR and why?
What happens to CO?
What happens to Cre?
(figure)

Answer 1

Fall in BP
Decrease in SVR: refractory of ang II, increased NO and relaxin
Increase in cardiac output
SCre drops a little (~0.5)

Question 2

What kind of AB DO in normal pregnancy?
Hormone responsible?

Answer 2

Resp Alk

Question 3

What is the BP cutoff to treat in pregnancy?

Answer 3

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)

Question 4

What are the best HTN meds in preg?
Alpha blocker? Beta blocker? CCB? Diuretics? Other?

Answer 4

Question 5

What medication do we try to avoid due to cyanide content in pregancy?

Answer 5

Avoid nitroprusside

Question 6

When should you use nitroglycerin infusion?
Magnesium?

Answer 6

Nitro when there is pulmonary edema
Mag is used to prevent eclampsia

Question 7

What is your management in HTN emergencies in pregnancy?

Answer 7

Question 8

What are some common causes of ATN?

Answer 8

Question 9

What are some common pre-renal causes of AKI?
(figure)

Answer 9

Question 10

What are some common intrinsic causes for AKI?
(figure)

Answer 10

Question 11

What is acute cortical necrosis? What are some pregnancy related causes?
(figure)

Answer 11

Question 12

What are 5 pregnancy disorders that can give you TMA?

Answer 12

Question 13

Dx criteria for pre-eclampsia?
(figure)

Answer 13

new criteria when there is no proteinuria (ACOG 2013)

Question 14

What are some preventative measures to provide against preeclampsia?

Answer 14

Calcium and low dose ASA

Question 15

Whats the treatment for preeclampsia? What’s the cure

Answer 15

magnesium sulfate
Delivery is the cure (remove the placenta)

effective in preventing initial and recurrent seizures, and lowers maternal morality

Question 16

When does PEC/eclampsia occur? Pre, peri, or post-partum?

Answer 16

Can occur anytime, even post partum

Question 17

Hyperbili, high NH3, hypoglycemia, liver failure, increased liver enzymes
What is the condition?

Answer 17

Question 18

When is promp termination of pregnancy warranted?

Answer 18

Acute fatty liver of pregnancy (with LCHAD deficiency)

Question 19

TTP/HUS figures
Can you give eculizumab in pregnancy?

Answer 19

Yes, you can give eculizumab in pregnancy

Question 20

What are some maternal and fetal complication of SLE?
(figure)

Answer 20

Question 21

When do you biopsy in pregnancy?

Answer 21

You don’t.

Question 22

When do you stop hydroxychloroquine during pregnancy?

Answer 22

You don’t.

Lupus nephritis can look like HELLP, but here the liver is spared

Question 23

AKI in pregnancy
(figure)

Answer 23

Question 24

Pyelo in pregnancy - what is the managment?

Answer 24

Hospitalization and IV abx (high risk for sepsis)

Question 25

Preffered abx in pregnancy (figure)

Answer 25

Question 26

AKI timing in pregnancy (figure)

Answer 26

Question 27

DM nephropathy increases your risk of what during pregnancy?

Answer 27

Question 28

When do you discontinue the ACE/ARB? BP goal?

Answer 28

User for at least 6mo prior to conception (better outcomes) D/C ACE/ARB when trying to concieve 110-130/ 70-90 ## Footnote Low dose ASA

Question 29

ADPKD and pregnancy (figure)

Answer 29

Question 30

Meds that are safe in pregnancy (figure)

Answer 30

Question 31

What ACEi are safe in breastfeeding?

Answer 31

Enalapril, captopril, quinalapril

Question 32

When to start HD in pregnancy? BUN goals? Anemia management/treatment? MBD management/treatment? (figure)

Answer 32

Question 33

Pregnant transplant patients are at a higher risk of what?

Answer 33

PEC, preterm birth, low birth weight, c-section

Question 34

What IS meds should you avoid?

Answer 34

MMF and cyclophos mTORs as well (limited data) ## Footnote Stop all at least 12wks prior to conception mTORs: impaired spermatogenesis

Question 35

CNI levels are usually higher or lower in pregnancy?

Answer 35

Lower CNI levels in pregnany (get labs like monthly instead of every 3 or 6m)

Question 36

What IS is ok to use in breastfeeding?

Answer 36

Tac, aza, pred

Question 37

Normal physiology of pregnancy (figure)

Answer 37

Question 38

HTN treatment in pregnancy (figure)

Answer 38

Question 39

AKI in pregnancy (figure)

Answer 39

Question 40

CKD in pregnancy (figure)

Answer 40

Question 41

GN/HD/Transplant in pregnancy (figure)

Answer 41