Renal Disease In Pregnancy

Question 1

Bacteria count to tell there is UTI

Answer 1

> 100,000

If less; contamination

Question 2

What is the most common infection in women

Answer 2

UTI

Question 3

The most common type of sepsis in pregnanxy

Answer 3

Urinary sepsis

Question 4

1st line ttt of UTI in pregnancy

Answer 4

• trimethoprim (not in 1st trimester)
• nitrofurantoin ( not in 3rd trimester)

2nd line: Gentamicin

Question 5

SE of nitrofurantoin

Answer 5

Oral & genital candidiasis
GIT Symp
Liver toxicity
Rare lung toxicity

Question 6

Minimise urine sample contamination

Answer 6

Use of sterile catheter samples
Midstream sample of urine

Question 7

Most causative organism of UTI in pregnancy

Answer 7

E coli 80-90%
2nd: staph saprophyticus
GBS

Question 8

Sequelae of asymptomatic bacteruria

Answer 8

Cystitis - up to 30%
Pyelonephritis - up to 50%

Question 9

Screening tests for asymptomatic bacteruria

Answer 9

Routine MSSU screening in early pregnancy
If positive; follow up cultures

Question 10

Presence of nitrites in urine of symptomatic women suggests

Answer 10

Strongly suggests significant bacteruria -> final diagnosis with quantitative urine culture

Question 11

Anyibiotic regimen in asym. Bacteruria, pyelonephritis and cystitis

Answer 11

1. Asymptomatic bacteriuria: 1w
2. A. Pyelonephritis: 3 w
3. Cystitis: 7-10 days

Question 13

1st line ttt of acute cystitis

Answer 13

Increasing oral fluid intake

Question 14

Symptoms of cystitis

Answer 14

Dysuria
Frequency
Urgency
Suprapubic pain

Question 15

The diagnostic gold standard im pyelonephritis

Answer 15

Renal biopsy but it is impractical

Question 16

Management of pyelonephritis

Answer 16

Admission or outpatient
Oral and IV AB
blood culture
Vaginal swaps
MMSU for culture b4 ttt
- Start embirical AB unitl women is afebrile for 24 hrs then start AB according to c&S
- analgesia
- Thromboprophylaxis (stocking- LMWH)
- Tocolysis as PTL risk increases
- steroids for lung maturity

Question 17

What cases we avoid NSAIDs

Answer 17

• CKD
• PET
• OHSS
• SCD (12-31w)

Question 18

Analgesia accepted in renal diseases

Answer 18

paracetamol and opioids
Avoid NSAIDs

Question 19

NSAIDS effect on pregnancy

Answer 19

Oligohydramnios
Premature ductus arteriosus closure
Gastric ulcer
Renal perfusion

Question 20

The most common reason for initial ttt failure in pyelonephritis

Answer 20

• AMR
• underlying pathology or renal tract anomaly
• renal calculi

Question 21

What is recurrent UTI

Answer 21

3 UTI on a year
Or
2 UTI IN 6 months

Question 22

Prevention of RUTI in pre and postmenopausal women

Answer 22

Pre MP: glycosaminoglycan
Post MP: Estrogen

Question 23

What test we use to assess renal function in pregnancy

Answer 23

S. creatinine (don’t use GFR)

Question 24

Do s creatinine level is the same during pregnancy

Answer 24

It falls be 35 ug/ l in pregnancy
From 80 to 53

If >90 diagnostic of AKI IN pregnancy

Question 25

Renal changes during pregnancy

Answer 25

1. GFR INC -> so s. Creatinine and urea falls 2. Renal plasma flow inc in 1st and 2nd, falls in 3rd 3. Proteinuria common but not >300mg/24 hrs

Question 26

Most common cause of AKI in pregannxy

Answer 26

Preeclampsia

Question 27

Percentage of cases of AKI passed undiagnosed in pregnancy

Answer 27

40%

Question 28

Indications for renal replacement therapy in AKI

Answer 28

Severe AKI Irresponsive to ttt CKD w/ superimposed AKI Metabolic alkalosis Urea >17 mmol/l is teratogenic Hyperkalemia -> give calcium salt for cardiac stability

Question 29

Magnesium sulphat in PE and AKI

Answer 29

It is renal exerted. A loading dose 4g over 5-15 mins Maintenance dose reduced: 0.5 g/hr

Question 30

IV HYDRATION IN PET women

Answer 30

Associated witg pulmonary edema She must be kept dry 80ml/hr is recommended peripartum

Question 31

What is thrombotic microangiopathy

Answer 31

TTP (neuro sym) AND HUS (renal sym) thrombi in the microvasculature lead to consumptive thrombocytopenia, hemolysis and end organ damage

Question 32

Pathology of TTP

Answer 32

VWF forms platelet plugs, it goes breakdown by ADAM 13, if the latter is deficient -> platelet deposition of platelet rich thrombi in the microcirculation- ttp

Question 33

Rate of AKI with TTP

Answer 33

AKI occurs in 30-80% of pregnancy related TTP Much higher than TTP outside pregnancy

Question 34

Pathology of HUS

Answer 34

Pathological over-activation of complement leads to endothelial damage and renal injury

Question 35

HUS PROGNOSIS

Answer 35

Autosomal recessive HUS: - occurs in childhood - poor prognosis - frequent recurrence - mortality rate 60-70% Autosomal dominant HUS: - adults - poor prognosis - mortlaity rate: 50-90%

Question 37

When pregnancy related HUS usually occur

Answer 37

Postpartum, when placental expression of complement regulatory proteins is lost

Question 38

Management of HUS/TTP

Answer 38

FFP infusion Eculizumab (if adam13 <10%)