Renal disease

Question 1

The American Society of Transplantation Consensus Opinion states that a patient following a renal transplant can safely proceed with pregnancy providing the following conditions are met:

Answer 1

Graft function is optimal, defined as CR<132 with <500mg/24 hour protein excretion

No concurrent fetotoxic infections, such as CMV

The patient is not on known teratogenic or fetotoxic meds

The immunosuppressive regimen is stable at maintenance levels

Question 2

What are the features of acute rejection of a renal transplant?

Answer 2

Deteriorating renal function

Fever

Oliguria

Graft swelling and tenderness

Altered echogenicity of renal parenchyma and blurring of corticomedullary junction on USS

Question 3

Which immunosupressive drugs are safe in pregnancy and which ones should be avoided?

Answer 3

Safe in pregnancy:

Prednisolone

Azathiorpine

Tacrolimus

Ciclosporin

Drugs to avoid:

Mycophenolate mofetil (MMF)

Sicrolimus (rapamycin)