Renal Disease in Pregnancy

Question 1

What levels of creatinine and urea warrant further investigation in pregnancy?

Answer 1

1. Creatinine >75

2. Urea >4.5

Question 2

What does asymptomatic bacteriuria increase the risk of and why?

Answer 2

Pyelonephritis due to relaxation of the ureters.

Question 3

What are the investigations for identifying asymptomatic bacteriuria in pregnancy?

Answer 3

1. MSU for all at booking

2. At every visit, dip urine, if nitrates +ve then MSU

Question 4

What is the treatment for asymptomatic bacteriuria in pregnancy?

Answer 4

1. Trimester 1 and 2 - cefalexin/nitrofurantoin

2. Trimester 3 - trimethoprim

Question 5

What is this a presentation of?

Lower urinary tract symptoms, fever, tachycardia, vomiting, loin pain.

Answer 5

Pyelonephritis

Question 6

What is the treatment for pyelonephritis in pregnancy?

Answer 6

1. IV antibiotics for at least 24 hours, step down to oral for 2 weeks.
2. If >2 UTIs in pregnancy - USS KUB and low dose amoxicillin/cefalexin prophylaxis for remaining pregnancy.

Question 7

What are the risks involved in CKD in pregnancy?

Answer 7

Miscarriage, pre-eclampsia, IUGR, fluid overload, polyhydramnios, preterm delivery
(Avoid pregnancy in CKD)

Question 8

What are the obstetric causes of an AKI?

Answer 8

1. Sepsis - miscarriage, puerperal, urinary
2. Haemolysis - HELLP, acute fatty liver, sickle crisis, malaria
3. Hypovolaemia - PPH, abruption
4. Volume contraction - pre-eclampsia, hyperemesis gravidarum
5. Drugs - NSAIDs