Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 Lecture weeks > Renal Disease and Pregnancy (1) > Flashcards

Renal Disease and Pregnancy (1) Flashcards

1
Q

What do we need to remember about when interpreting renal ultrasound in a pregnant woman?

A

Renal calyces and ureters dilate in pregnancy

This is due to high levels of progesterone inducing smooth muscle relaxation throughout the body (so uterus does not contract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is symptomatic hydronephrosis in pregnancy?

A

Aching back pain due to backpressure to the kidney -> as ureters are dilated

* normally benign but painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens to renal plasma flow and GFR in pregnancy?

A

GFR and renal plasma flow increase

* this is due to CVSan increase changes e.g. in stroke volume and HR

* happen in early stages of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to a urinary protein that is excreted (in pregnancy)?

A

Urinary protein and creatinine excretion will be increased

*this is due to increased renal blood flow and GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the upper limit of serum creatinine for a woman in the 2nd trimester of the pregnancy?

A

65 umol/l-it falls

* as renal clearance of creatinine is increased (so more creatinine is cleared off - less stays in serum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the upper limit for proteinuria throughout the pregnancy?

A

300 mg/24 hours

* limit is increased due to increased GFR - more protein excreted in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common disorders of renal system in pregnancy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is UTI more common in pregnancy?

A

UTI is more common in pregnancy because of physiological dilatation of the upper renal tract -> less peristalsis of ureters -> more opportunity to the bugs to invade(ascend)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Factors that increase risk of UTI in pregnancy

A
  • previous Hx of UTI
  • diabetes
  • steroids
  • immunosuppression
  • polycystic kidneys
  • congenital abnormalities of renal tract
  • neuropathic bladder (e.g. spina bifida, MS)
  • urinary tract calculi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do we do in terms of UTI screen during antenatal visits?

A

Screen MSU - to look for asymptomatic bacteriuria *

* additional MSU are indicated in pregnancy for those at increased risk of UTI or with symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of lower UTI

A

Lower UTI

  • urinary frequency
  • dysuria
  • haematuria
  • proteinuria
  • suprapubic pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms suggestive of pyelonephritis

A
  • fever
  • loin/ abdominal pain
  • vomiting
  • rigors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is seen on urine dipstick

A
  • nitrites
  • leukocyte esterase
  • proteinuria

The dipstick should be followed by MSU (to confirm diagnosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What Dx do we consider if proteinuria found on the dipstick in late pregnancy?

A

Always considered pre-eclampsia unless ruled out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do we consider as significant bacteriuria?

A

> 106 organisms/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What if we do MSU culture and there would be non-significant/mixed growth?

A

Repeat with a fresh specimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do we treat bacteriuria in pregnancy?

A

It is to prevent pyelonephritis and preterm delivery

18
Q

How long is a Rx for asymptomatic bacteriuria?

A

3 days for asymptomatic bacteriuria

*but 7 - 10 days for pyelonephritis

19
Q

What do we need to investigate after the Rx of asymptomatic bacteriuria?

A

Regular urine cultures - to make sure we eradicated the bacteria

*2nd course of antibiotics may be required

20
Q

What antibiotics for UTI/ bacteriuria are safe in pregnancy?

A
  • Penicillins (amoxycillin, augmentin), Co-amoxiclav (amoxicillin + clavulanic acid)
  • cephalosporins
21
Q

What antibiotic to avoid in 3rd trimester?

A

Nitrofurantoin - to be avoided in 3rd trimester

*haemolytic actions - baby vulnerable to haemolytic anaemia

22
Q

What antibiotic to avoid in 1st trimester of pregnancy?

A

Trimethoprim

* it is anti-folate drug -> neural tube defects (e.g. spina bifida)

23
Q
A
24
Q

How long is a Rx in pregnancy:

  • acute cystitis
  • pyelonephritis
A
  • acute cystitis -> 7-day course
  • pyelonephrtis -> 10 - 14 days
25
Q

Pyelonephritis + vomiting or pyrexia in a pregnant woman

  • what to do?
A

Admit for IV antibiotics + IV fluids (until apyrexial)

26
Q

What further investigations do we do if a pregnant woman has pyelonephritis or >1 proven UTI?

A
  • check renal function
  • renal USS

* we want to exclude hydronephrosis, congenital abnormalities, calculi)

27
Q

What if a pregnant woman has >1 UTIs + risk factor

A

continuous prophylactic antibiotics

28
Q

What are the commonest causes of renal impairment in women of childbearing age:

A
  • reflux nephropathy
  • diabetes
  • SLE
  • other forms of glomerulonephritis
  • polycystic kidney disease
29
Q

How do we classify renal impairment?

A

mild, moderate or severe -> depends on serum creatinine or GFR

30
Q

What renal disease may first manifest with in a pregnancy?

What further Ix should these signs prompt?

A
  • hypertension
  • proteinuria
  • +/- haematuria

Further Ix: urea and creatinine

31
Q

How reflux nephropathy can lead to renal impairment?

A

Recurrent reflux -> recurrent UTI -> scarring -> renal impairment

32
Q
A
33
Q

Complications of renal disease on pregnancy outcome (3)

A
  • pre-eclampsia
  • prematurity
  • IUGR

*outcome depends on the level of impairment and pre-existing hypertension

*common to all these happen at the same time (as Rx for PE is delivery)

34
Q
A
35
Q

What is a chance of a successful pregnancy in severe renal impairment?

A

<50%

Due to frequent severe pre-eclampsia + IGUR

36
Q

What should we counsel a woman in terms of pregnancy if she’s got a severe renal impairment?

A

Counsel against pregnancy/delay until she had a kidney transplant

*due to risk of bad outcomes for mum and baby

37
Q

What can happen (apart from PE, IGUR, premature birth) in a pregnancy if a woman has a severe renal impairment?

A

Development of polyhydramnios -> leading to cord prolapse

*this results from foetal polyuria in response from high osmotic load from increased maternal urea

38
Q

What high urea in a women does to fertility?

A

High urea = embryotoxic - woman unlikely to get pregnant

*if get pregnant there is a high chance of spontaneous miscarriage

39
Q

Why does polyhydramnios develop in a woman with severe renal impairment?

A

this results from foetal polyuria in response from high osmotic load from increased maternal urea

40
Q

What complications are associated with nephrotic syndrome + heavy proteinuria

A
  • worsening hypo-albuminaemia
  • risks of pulmonary oedema and thrombosis

Y3 Lecture weeks (65 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions