RENAL AND URINARY TRACT DISORDERS OF PREGNANCY (AB)

Question 1

Which hormone-induced change in pregnancy causes dilation of the renal calyces and ureters?

Answer 1

Progesterone-induced relaxation of the muscularis

Question 2

Why is marked dilatation of the ureters more apparent in mid-pregnancy?

Answer 2

Increased distal ureteral compression, especially on the right side

Question 3

What physiologic change in pregnancy increases the risk of upper urinary tract infections?

Answer 3

Vesicoureteral reflux

Question 4

Why might imaging studies for urinary tract obstruction in pregnancy be misinterpreted?

Answer 4

Physiologic changes in the urinary tract can mimic obstruction

Question 5

What renal structural change occurs during pregnancy without an increase in cell numbers?

Answer 5

Glomerular enlargement

Question 6

What happens to renal plasma flow (RPF) and glomerular filtration rate (GFR) during pregnancy?

Answer 6

RPF increases by 40% and GFR by 65%

Question 7

How do creatinine and urea levels change during pregnancy?

Answer 7

Both decline substantially

Question 8

What is asymptomatic bacteriuria?

Answer 8

Persistent, actively multiplying bacteria in the urinary tract without symptoms

Question 9

What is the diagnostic threshold for bacteriuria in a voided urine specimen?

Answer 9

≥105 colony-forming units (CFU)/mL

Question 10

When do guidelines recommend screening for asymptomatic bacteriuria in pregnancy?

Answer 10

At the first prenatal visit

Question 11

What should be done if a pregnant woman’s initial urine culture is positive?

Answer 11

Prompt treatment

Question 12

Why might asymptomatic bacteriuria be treated at lower bacterial counts?

Answer 12

Pyelonephritis can develop even with 20,000-50,000 CFU/mL

Question 13

What percentage of untreated asymptomatic bacteriuria cases develop symptomatic infection during pregnancy?

Answer 13

Approximately 25%

Question 14

What are two cost-effective screening tests for asymptomatic bacteriuria in pregnancy?

Answer 14

Leukocyte esterase and nitrite dipstick tests

Question 15

Is susceptibility testing always necessary for treating asymptomatic bacteriuria?

Answer 15

No, initial treatment is empirical

Question 16

What is the single-dose treatment option for asymptomatic bacteriuria?

Answer 16

Amoxicillin 3g, Ampicillin 2g, Cephalosporin 2g, Nitrofurantoin 200mg, Trimethoprim-sulfamethoxazole 320/1600mg

Question 17

What are common 3-day treatment regimens for asymptomatic bacteriuria?

Answer 17

Amoxicillin 500mg TID, Ampicillin 250mg QID, Cephalosporin 250mg QID, Ciprofloxacin 250mg BID, Levofloxacin 250-500mg daily, Nitrofurantoin 50-100mg QID or 100mg BID, TMP-SMX 160/800mg BID

Question 18

What is the first-line treatment for recurrent bacteriuria in pregnancy?

Answer 18

Nitrofurantoin 100mg at bedtime for 21 days

Question 19

What is the preferred suppressive therapy for persistent bacteriuria?

Answer 19

Nitrofurantoin 100mg at bedtime for the remainder of pregnancy

Question 20

What is the most common cause of sepsis in pregnant patients?

Answer 20

Acute pyelonephritis

Question 21

Which side is more commonly affected in acute pyelonephritis during pregnancy?

Answer 21

Right side

Question 22

What are the hallmark symptoms of acute pyelonephritis?

Answer 22

Fever, shaking chills, lumbar pain

Question 23

What physical exam finding suggests acute pyelonephritis?

Answer 23

Costovertebral angle tenderness

Question 24

What are the common bacterial causes of acute pyelonephritis in pregnancy?

Answer 24

E. coli (70-80%), Group B Strep/S. aureus (10%), Klebsiella pneumoniae (3-5%), Enterobacter/Proteus spp (3-5%)

Question 25

What is the cornerstone of acute pyelonephritis treatment?

Answer 25

Intravenous hydration

Question 26

Why is plasma creatinine monitored in acute pyelonephritis?

Answer 26

5% of pregnant women develop renal dysfunction despite fluid resuscitation

Question 27

What respiratory complication can occur in 10% of acute pyelonephritis cases?

Answer 27

Acute respiratory distress syndrome (ARDS)

Question 28

What is a common hematologic complication of pyelonephritis?

Answer 28

Endotoxin-induced hemolysis leading to anemia

Question 29

What is the initial antimicrobial therapy for acute pyelonephritis in pregnancy?

Answer 29

Ampicillin + Gentamicin, Cefazolin or Ceftriaxone, Extended-spectrum antibiotics

Question 30

What are the key steps in managing acute pyelonephritis in a pregnant patient?

Answer 30

Hospitalization, urine and blood cultures, CBC, creatinine, electrolytes, IV fluids, IV antibiotics, chest X-ray if needed, monitor vitals and urinary output

Question 31

What are the criteria for discharge after treating acute pyelonephritis?

Answer 31

Afebrile for 24 hours, completion of IV antibiotics, switch to oral antibiotics for 7-10 days

Question 32

What should be done 1-2 weeks after finishing antibiotics for acute pyelonephritis?

Answer 32

Repeat urine culture

Question 33

Why are pregnant women prone to nephrolithiasis?

Answer 33

Urinary pH elevation reduces calcium phosphate solubility

Question 34

What is the most common type of kidney stone in pregnancy?

Answer 34

Calcium phosphate or hydroxyapatite

Question 35

What is the primary symptom of nephrolithiasis in pregnancy?

Answer 35

Pain

Question 36

What imaging modality is preferred for detecting nephrolithiasis in pregnancy?

Answer 36

Sonography

Question 37

What sonographic sign may help rule out urinary obstruction?

Answer 37

Ureteral 'jets' on color Doppler

Question 38

What dietary changes help prevent recurrent kidney stones?

Answer 38

Low sodium and low protein diet

Question 39

What medication reduces the risk of recurrent nephrolithiasis?

Answer 39

Thiazide diuretics

Question 40

What are the first-line treatments for nephrolithiasis in pregnancy?

Answer 40

Intravenous hydration and analgesics

Question 41

When is nephrolithiasis an emergency in pregnancy?

Answer 41

When there is urinary obstruction with infection ('pus under pressure')

Question 42

What percentage of symptomatic nephrolithiasis cases resolve with conservative management?

Answer 42

65-80%

Question 43

What procedures may be required for persistent nephrolithiasis in pregnancy?

Answer 43

Ureteral stenting, ureteroscopy, percutaneous nephrostomy, transurethral laser lithotripsy, or basket extraction

Question 44

What stone treatment is contraindicated in pregnancy?

Answer 44

Extracorporeal shock wave lithotripsy

Question 45

What are the six syndromes of glomerular injury?

Answer 45

"Acute nephritic syndromes. pulmonary-renal syndromes. nephrotic syndromes. basement membrane syndromes. glomerular vascular syndromes. infectious disease-associated syndromes."

Question 46

What is the clinical presentation of acute nephritic syndrome?

Answer 46

"Hypertension. hematuria. red-cell casts. pyuria. proteinuria."

Question 47

What are the common complications of acute nephritic syndrome?

Answer 47

"Edema. hypertension. circulatory congestion. renal insufficiency."

Question 48

What is the most common form of acute glomerulonephritis worldwide?

Answer 48

"IgA nephropathy (Berger disease)."

Question 49

What syndrome involves both glomerulonephritis and pulmonary hemorrhage?

Answer 49

"Goodpasture syndrome."

Question 50

What is the prognosis of acute nephritic syndrome?

Answer 50

"Varies by etiology; some recede spontaneously. others lead to rapidly progressive glomerulonephritis or chronic glomerulonephritis."

Question 51

What is the hallmark feature of nephrotic syndrome?

Answer 51

"Heavy proteinuria."

Question 52

What are the key characteristics of nephrotic syndrome?

Answer 52

"Hypoalbuminemia. hypercholesterolemia. edema."

Question 53

What are common causes of nephrotic syndrome?

Answer 53

"Minimal change disease. focal segmental glomerulosclerosis. membranous glomerulonephritis. diabetic nephropathy."

Question 54

What are potential complications of nephrotic syndrome?

Answer 54

"Hypertension. renal insufficiency. arterial and venous thrombosis. renal vein thrombosis."

Question 55

What factors increase thromboembolism risk in nephrotic syndrome?

Answer 55

"Platelet hyperactivity. urinary loss of antithrombotic factors. increased prothrombotic factor production by the liver."

Question 56

How does nephrotic syndrome affect pregnancy outcomes?

Answer 56

"Outcomes depend on severity; increased risk of preeclampsia. edema. chronic hypertension. renal insufficiency."

Question 57

What are the worst prognostic indicators for pregnancy outcomes in nephrotic syndrome?

Answer 57

"Serum creatinine >1.4 mg/dL. 24-hour protein excretion >1 g/day."

Question 58

What is a common renal biopsy finding in nephrotic syndrome?

Answer 58

"Microscopic abnormalities that guide treatment."

Question 59

What dietary recommendation is given for nephrotic syndrome?

Answer 59

"Normal amounts of high-biological-value protein."

Question 60

What are the main treatments for nephrotic syndrome?

Answer 60

"Glucocorticosteroids. immunosuppressants. cytotoxic drugs. treating underlying causes."

Question 61

What is the risk of chronic hypertension in pregnant women with nephrotic syndrome?

Answer 61

"Up to half of affected women may require treatment for chronic hypertension."

Question 62

What is the relationship between nephrotic syndrome and preeclampsia?

Answer 62

"Preeclampsia is common and often develops early in pregnancy."

Question 63

How does pregnancy impact proteinuria in nephrotic syndrome?

Answer 63

"Daily protein excretion may rise as pregnancy progresses."

Question 64

What is a common sign of severe edema in pregnant women with nephrotic syndrome?

Answer 64

"Massive vulvar edema."

Question 65

What is chronic kidney disease (CKD)?

Answer 65

A pathophysiological process that can progress to end-stage renal disease.

Question 66

What are the six stages of chronic kidney disease based on GFR?

Answer 66

Stage 0: GFR > 90 ml/min/1.73m²; Stage 5: GFR < 15 ml/min/1.73m².

Question 67

What are the leading causes of end-stage renal disease requiring dialysis or transplantation?

Answer 67

Diabetes (35%), Hypertension (25%), Glomerulonephritis (20%), Polycystic kidney disease (15%).

Question 68

How is renal function categorized based on serum creatinine levels?

Answer 68

Normal/Mild: <1.5 mg/dL; Moderate: 1.5–3.0 mg/dL; Severe: >3.0 mg/dL.

Question 69

What are the major risks of pregnancy in women with chronic renal disease?

Answer 69

High incidence of hypertension, preeclampsia, preterm birth, growth restriction, and worsening renal function.

Question 70

How does pregnancy affect renal plasma flow and GFR in women with mild renal insufficiency?

Answer 70

Pregnancy increases renal plasma flow and GFR.

Question 71

How does severe chronic renal insufficiency affect blood volume expansion during pregnancy?

Answer 71

It curtails normal pregnancy-induced hypervolemia, leading to only 25% volume expansion.

Question 72

What common hematologic condition is seen in women with chronic renal disease?

Answer 72

Chronic anemia due to intrinsic renal disease.

Question 73

What are the key lab values monitored in chronic renal insufficiency during pregnancy?

Answer 73

Serum creatinine, protein/creatinine ratio, 24-hour protein excretion.

Question 74

Why is bacteriuria treated in women with chronic kidney disease?

Answer 74

To decrease the risk of pyelonephritis and further nephron loss.

Question 75

What dietary recommendation is given for chronic kidney disease?

Answer 75

Protein-rich diet.

Question 76

What is a common side effect of recombinant erythropoietin used for anemia in CKD?

Answer 76

Hypertension.

Question 77

What imaging modality is used to monitor fetal growth in CKD pregnancies?

Answer 77

Serial sonography.

Question 78

What biomarkers may help differentiate chronic hypertension from preeclampsia?

Answer 78

Placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1).

Question 79

How can pregnancy accelerate chronic renal disease progression?

Answer 79

By increasing hyperfiltration and glomerular pressure, leading to worsening nephrosclerosis.

Question 80

What is a marker for the future development of renal failure?

Answer 80

Chronic proteinuria.

Question 81

When is dialysis recommended during pregnancy?

Answer 81

When serum creatinine levels reach 5–7 mg/dL.

Question 82

Why is dialysis frequency increased during pregnancy?

Answer 82

To avoid abrupt volume changes that can cause hypotension.

Question 83

What key substances must be replaced during dialysis in pregnancy?

Answer 83

Multivitamins, calcium, iron salts, dietary protein, and calories.

Question 84

What maternal complications are common in pregnancy with dialysis?

Answer 84

Severe hypertension, placental abruption, heart failure, sepsis.

Question 85

What fetal complications are associated with maternal dialysis?

Answer 85

Preterm birth, growth restriction, stillbirth, and hydramnios.

Question 86

What is acute kidney injury (AKI)?

Answer 86

Sudden impairment of kidney function with retention of nitrogenous waste products.

Question 87

What are common causes of acute renal ischemia in pregnancy?

Answer 87

Severe preeclampsia, hemorrhage, HELLP syndrome, placental abruption, septicemia.

Question 88

How is AKI typically diagnosed?

Answer 88

An abrupt rise in serum creatinine and oliguria.

Question 89

What is the first-line management of AKI in pregnancy?

Answer 89

Volume replacement and treatment of underlying causes.

Question 90

When is renal replacement therapy (dialysis/hemofiltration) indicated in AKI?

Answer 90

When severe oliguria and azotemia persist.

Question 91

Which medications require dose adjustment in AKI?

Answer 91

Magnesium sulfate, iodinated contrast agents, aminoglycosides, NSAIDs.

Question 92

What is the role of early dialysis in AKI?

Answer 92

It reduces maternal mortality.

Question 93

What is the most common cause of AKI in obstetrics?

Answer 93

Acute blood loss, often associated with preeclampsia or massive hemorrhage.

Question 94

What are the key strategies to prevent AKI in obstetric patients?

Answer 94

Prompt fluid replacement, early delivery in severe preeclampsia, monitoring for sepsis, avoiding unnecessary vasoconstrictors and diuretics.