Renal

Question 1

How does renal function change in pregnancy?

Answer 1

Creatinine and urea fall during pregnancy
Glycosuria usually reflects altered renal physiology rather than hyperglycaemia
Dilatation of calyces and ureters

Question 2

What important urine screening occurs at booking visit? Why?

Answer 2

Urine culture for asymptomatic bacteria

- This can go on to develop pyelonephritis with the dilatation of the calyces and ureters that occur in pregnancy

Question 3

What are risks of pyelonephritis in pregnancy?

Answer 3

Fetal growth restriction
Fetal death
Premature labour

Question 4

What is done if asymptomatic bacteruria is found?

Answer 4

Treatment
e.g. cefalexin 500mg TDS PO
Trimethoprim and nitrofurantoin are safe alternatives at certain points in pregnancy

Check MSI on regular basis to ensure eradication

Question 5

When should trimethoprim and nitrofurantoin be avoided in pregnancy? Why?

Answer 5

Trimethoprim (GOOD IN Third Trimester)

• Avoid in first trimester
• Anti-folate action

Nitrofurantoin

• avoid in 3rd trimester
• Neonatal haemolytic anaemia

Question 6

What are features of acute cystitis?

Answer 6

Frequency
Urgency
Dysuria
Haematuria
Lower abdominal pain

Question 7

What organism is most likely to cause UTI?

Answer 7

E. coli

Question 8

What urine dip results suggest UTI?

Answer 8

Nitrites +++

Leucocytes +++

Question 9

How does pyelonephritis present?

Answer 9

(Ascending UTI more common in pregnancy due to dilatation of upper renal tract)

Urinary frequency
Fever
Tachycardia
Loin pain
Comiting

Question 10

When should you check urine?

Answer 10

Hyperemesis gravidarum

Premature labour

Question 11

What is management for pyelonephritis?

Answer 11

Blood and urine culture

IV antibiotics (e.g. cefuroxime)
If septic - manage via sepsis 6

Continue IV abx for 24h and oral for 2-3 weeks

Monitor MSU for eradication
Check renal function regularly

Low does oral amoxicillin or cefalexin may be used as prophylaxis

Question 12

What should be done if 2+ UTI in pregnancy?

Answer 12

Renal US to exclude stones and abnormalities

Antibiotic prophylaxis for pregnancy - consider

Question 13

What are obstetric causes of AKI?

Answer 13

Sepsis (septic miscarriage, puerperal sepsis, urinary sepsis)
Haemolysis (HELLP, acute fatty liver, sickle cell, malaria)
Hypovolaemia (blood loss from PPH or abruption)
Voilumecontraction (pre-eclampsia, hyperemesis gravidarum)
Drugs - NSAIDs

Question 14

Management for AKI in pregnancy?

Answer 14

Cetherise and monitor UO
Aim for >30ml/h
Monitor renal function U&E
Treat cause
Dialysis if required