Renal conditions Flashcards
What are the normal changes to the renal system in pregnancy?
Increased blood flow; Increased glomerular filtration, increased kidney size, increased risk of UTI, overt proteinuria is abnormal.
Glycosuria is common - not indicative of diabetes.
What are the three types of renal disease?
Congenital - primary defects of the kidney tissue usch as obstruction of the urinary tract, cystic and metabolic diseases, syndromes.
Acute - infection, nephrotic syndrome, poisoning
Chronic - diabetes, hypertension, glomerulonephritis, cancer, medication use.
What risks do UTI’s in pregnancy bring?
Risk of low birth weight, preterm birth and IUGR for fetus.
Pyelonephritis in mother;
Associated with hypertension and anaemia.
What are the symptoms of cystitis?
Frequency of micturition Dysuria, Abdominal discomfort slight temperature increased pulse rate
What is pyelonephritis?
Occurs in 2% of pregnant women. A systemic infection indicated by pyrexia, rigors, nausea and vomiting and flank pain.
What is costovertebral angle tenderness?
It is pain elicited from percussion on the back over the kidney which indicates kidney infection. The location is the costovertebral angle which is an angle made by the vertebral column and the costal margin, or the acute angle formed on either side of the human back between the twelfth rib and the vertebral column.
All women should be offered MSU screening in early pregnancy. T or F?
True - as asymptomatic bacteriuria can lead to preterm birth and low birthweight.
What is the management of acute pyelonephritis?
Admit to hospital, IV antibiotics (changing to oral when tolerated), IV fluids and analgesia. Monitor renal function and consider renal ultrasound.
Hourly observations (temp, BP, Pulse) Accurate fluid balance chart
What is the management of UTI in labour?
If maternal pyrexia and tachycardia, need CTG monitoring as may cause tachy in fetus.
Commence antibiotics
Avoid catheter where possible as increased risk of infection
Postpartum considerations for recurrent UTI’s?
GP follow up - if persists after pregnancy - renal ultrasound (also for baby to check for reflux and nephropathy).
What are the risks with chronic kidney disease?
IUGR Preeclampsia Premature birth Fetal loss UTI Deteriorating renal function
What are the complications that may come with chronic kidney disease?
Hypertension Fluid retention Anaemia Heavy proteinuria metabolic acidosis renal bone disease UTI Imparied renal function
How is chronic kidney disease managed in pregnancy?
Specific treatments continue;
Commence aspirin to prevent preeclampsia;
Regular bloods to monitor renal function;
Carefule BP monitoring;
Medication review;
Monitor urine for proteinuria;
Regular growth scans for baby.
What are some causes of chronic kidney disease?
Diabetes (most common) Hypertension Glomerulonephritis Cancer Medication use - aspirin, nurofen etc - can cause it, or worsen it, if taken frequently.
