Renal And UT Flashcards
What structural changes occur in the kidneys during pregnancy?
The kidneys become larger, and renal calyces and ureters dilate.
What is a major physiological consequence of intrarenal vasodilation in pregnancy?
Higher effective renal plasma flow and glomerular filtration.
By how much does the glomerular filtration rate (GFR) increase by 12 weeks’ gestation?
20 percent above nonpregnant values.
What serum markers decline substantively during pregnancy?
Serum creatinine and urea.
What is considered an abnormal level of proteinuria in pregnancy?
Proteinuria exceeding 300 mg/dL.
What organism most commonly causes non-obstructive pyelonephritis during pregnancy?
Escherichia coli strains.
What is asymptomatic bacteriuria (ASB) in pregnancy?
Persistent, actively multiplying bacteria within the urinary tract in asymptomatic women.
What bacterial count in urine culture defines ASB?
≥105 colony-forming units/mL.
What percentage of untreated women with ASB develop symptomatic infection?
Approximately 25 percent.
What screening tests are cost-effective for detecting bacteriuria in pregnancy?
Leukocyte esterase and nitrite dipstick tests.
What are the characteristic symptoms of cystitis?
Dysuria, urgency, and frequency.
What is the most common serious non-obstetrical medical complication of pregnancy?
Acute pyelonephritis.
What risk factors increase the likelihood of renal infection in pregnancy?
Nulliparity and young age.
What combination of antimicrobials was 95-percent effective in treating pyelonephritis?
Ampicillin plus gentamicin or cefazolin/ceftriaxone.
What is the recurrence rate of pyelonephritis after initial treatment in pregnancy?
30 to 40 percent.
What type of kidney stones is most common during pregnancy?
Calcium phosphate or hydroxyapatite stones.
What dietary recommendation helps prevent kidney stone recurrence?
Hydration and a diet low in sodium and protein.
What imaging modality is second-line for nephrolithiasis in pregnancy after a non-diagnostic sonogram?
Magnetic Resonance Imaging (MRI).
What percentage of symptomatic pregnant women improve with conservative therapy for nephrolithiasis?
Approximately 75 percent.
What are indications for stone removal in pregnancy?
Obstruction, infection, intractable pain, or heavy bleeding.
How does PKD affect pregnancy outcomes?
Higher rates of hypertension, preeclampsia, and urinary infections.
Does pregnancy accelerate the natural disease course of PKD?
No.
What condition is more common in women with polycystic kidneys?
Hypertension, including preeclampsia.
What factors determine the prognosis of pregnancy in women with PKD?
Degree of associated hypertension and renal insufficiency.
What is the defining GFR range for stage 5 CKD?
GFR <15 mL/min/1.73 m2.
What are common complications of CKD during pregnancy?
Hypertension, preeclampsia, preterm delivery, and fetal growth restriction.
What medication is recommended from 12 to 28 weeks to reduce preeclampsia risk in CKD patients?
Low-dose aspirin.
How does the severity of renal impairment affect pregnancy outcomes in CKD?
Directly correlates with adverse outcomes.
What dietary advice is NOT recommended for CKD patients during pregnancy?
Protein-restricted diets.
What is a hallmark sign of acute kidney injury in pregnancy?
Oliguria.
What conditions are common causes of AKI in pregnancy?
Pre-eclampsia, obstetrical hemorrhage, and sepsis.
What fluid replacement is advised for managing AKI in placental abruption?
Crystalloid solutions and blood.
What is the threshold for considering dialysis in pregnant women with AKI?
Creatinine clearance of 20 mL/min or less.
What measures prevent AKI due to massive hemorrhage in pregnancy?
Prompt volume replacement and delivery/termination of complicated pregnancies.
What is the hallmark feature of nephrotic syndrome?
Heavy proteinuria.
What clinical features characterize acute nephritic syndrome?
Hypertension, hematuria, red-cell casts, and proteinuria.
What systemic form of IgA nephropathy is associated with nephritic syndrome?
Henoch-Schönlein purpura.
What is Goodpasture syndrome?
Pulmonary-renal syndrome caused by anti-glomerular basement membrane antibodies.
What biopsy findings are common in pregnancy-associated glomerular diseases?
Membranous glomerulonephritis, IgA nephropathy, and diffuse mesangial glomerulonephritis.
What is the relationship between dialysis hours and pregnancy outcomes?
Inverse relationship with adverse outcomes.
What supplements are critical during dialysis in pregnancy?
Calcium, iron, and multivitamins.
What protocol adjustments are made to dialysate in pregnancy?
Extra calcium and reduced bicarbonate.
What is a common maternal complication of dialysis during pregnancy?
Severe hypertension.
What causes a urethral diverticulum in pregnancy?
Enlarging paraurethral gland abscess that ruptures into the urethral lumen.
How are urinary tract fistulas during pregnancy typically managed?
Expectantly, unless drainage or surgery is required.
What is a vesicouterine fistula?
A connection between the bladder and uterus, often following cesarean delivery.
What is a common cause of vesicocervical fistula in pregnancy?
Compression of the anterior cervical lip against the symphysis pubis.
