Renal

Question 1

UTI

Answer 1

Treat asymptomatic bacteriuria due to dilated renal tract (progesterone and compression related).

Question 2

CKD

Answer 2

Risks on CKD
- Renal function decline
- HTN in pregnancy
- Worsening proteinuria
- Flare of glomerulonephritis

Effect of CKD on preg
- Risk of miscarriage, PET, PTB, IUGR, SB

Severe CKD eGFR <15 recommended against pregnancy
Maternal urea >10mmol/L can cause polyhydramnios and PTB, fetal death above 20mmol/L

Diabetic nephropathy doubles the risk of women with diabetes and no nephropathy. Nephrotic SND can predispose to pulmonary oedema and thrombosis

Question 3

Glomerulonephritis

Reflux nephropathy

PKD

Dialysis

Answer 3

Similar risks
Less irreversible renal impairment

Reflux can be an AD condition and increases the risk of FGR.

AD or AR disorder
Associated with PLD, SAH

50% mortality rate for fetus - possibly better now
Extra things needed are increased dialysis to maintain urea <15mmol/L, increased heparinisation.

Question 4

Renal transplant

Answer 4

Reminder that ovulation will return likely quickly after transplant but waiting 1 year is a good idea.
Contraception.
Pregnancy outcome is based on HTN and Cr.

Effect on transplant: none if Cr <100
Drugs to continue: pred, azathiopurine, tacrolimus, ciclosporin
Drugs to avoid MMF, Sirolimus
Cover delivery with abx and stress steroids