Renal Flashcards
Renal adaptations in pregnancy
Increased kidney size and dilatation of the collecting system (r>l)
Increased GFR and increased creatinine clearance (50% higher at maximum)
Decreased serum cr and urea
Increased protein excretion (up to 300mg/24hrs)
Maternal impact of ckd
Worsening kidney function or proteinuria Potential flare of underlying disease Htn disorders of pregnancy Gtn htn Pet Hellp Complications of immunosuppression Miscarriage
Fetal impact ckd
Preterm birth Stillborn/nnd Low bw Fgr Sga
Mngt dialysis in pregnancy
Cervical length measurement Serial ca, po4, pth Daily protein intake 1.5-1.8g/day Liberisation of dietary phosphate Dry weight Del at 37w Haemodialysis preferred over peritoneal
Renal transplant
Normal fertility w normal kidney function
No live vaccines
Preg delay 2yewrs post transplant (achieve maintenance immunosuppression)
Aim cr <100
Immunosuppression: tacrolimus or cyclosporine, plus azathioprine and low dose prednisone
How long patient with SLE should wait to get pregnant
6 months
Antenatal management with renal disease
Two weeklyl visits until third trimester, then weekly
Growth scans from 24 weeks and fetal surveillance
Regular testing of renal function (monthly)
Monthly MSU and treatment of asymptomatic bacteruria if found
Renal phys
Monitor PET
Treat any infection
Exclude rejection with pyrexia
IOL if reaches EDD
Consider classical C/S if required
Fetal risk of CKD
Less number of glomeruli and increased long term risk of HTN/poor kidney function
When to do VTE prophylaxis with LMWH
Serum albumin <20
Uraemia in pregnancy fetal response
Polyhydramnios (baby functions as dialyzer)
Target urea
<18mmol/L
Haemodialysis level in pregnancy
Urea 17-20 OR
Where risks of PTD outweighs those with dialysis initiation
Treatment for graft rejection in pregnancy
Methylprednisolone
IV immunoglobulin
Risk PET in renal transplant patient
1:3 approx
Immunosuppressants in pregnancy
Prednisone
Azathioprine
Tacrolimus
Cyclosporine
