Pregnancy and the kidney

Question 1

types of hypertension in pregnancy

Answer 1

5% gestational hypertension- no fetal effects; onset after 20 weeks
Chronic hypertension- high rate of pre-eclampsia 25-50% develop
Pre-eclampsia- 5% pregnancies; develops after 20 weeks with organ involvement, normalisation by 3 months post partum

Question 2

Diagnosing pre-eclampsia

Answer 2

BP over 140/90 in patient with previously normal BP or increasing over pregnancy
P:Cr over 30 or over 300mg in 24 hours
dipstick unreliable
increased uric acid over 0.32
hypocalcuria
thrombocytopaenia
elevated transaminases

Question 3

Risk factors for pre-eclampsia

Answer 3

Multiple pregnancy
Primigravida
Multipara with new partner
Renal insufficiency
Early preg SBP over 120
Obesity
If have been a kidney donor!!
Transplant recipient renal 
Diabetes
Essential hypertension
positive FH
Prior PE
SLE, other autoimmune disorder

Question 4

What are the two things you can give high risk patients to reduce risk PE?

Answer 4

1. Calcium oral supplementation- 500mg QID from 25 weeks decreases risk of any cause of hypertension
2. Aspirin small benefit from 20 weeks

Question 5

Transplant pregnancy management?

Answer 5

low dose aspirin
BP daily check by patient
CNI levels and creatinine frequently
MSU and protein to creatinine ration monthly
Check asymptomatic CMV and toxo every trimester
Monitor renal function and BP post delivery
tThink about meds- pred less than 15mg/day- monitor baby for adrenal insufficiency. Aza doesn’t cross the placenta category D. Cyc A crosses placenta no effect on fetus. Drug levels in mother can change frequently
Tac- lower placental levels. MMF CANNOT GIVE. Sirolimus little data. Monoclonals can predispose to CMV and haem abnormalities in mother- avoid preg for one year after dose.