Renal Disease In Pregnancy Flashcards
Bacteria count to tell there is UTI
> 100,000
If less; contamination
What is the most common infection in women
UTI
The most common type of sepsis in pregnanxy
Urinary sepsis
1st line ttt of UTI in pregnancy
- trimethoprim (not in 1st trimester)
- nitrofurantoin ( not in 3rd trimester)
2nd line: Gentamicin
SE of nitrofurantoin
Oral & genital candidiasis
GIT Symp
Liver toxicity
Rare lung toxicity
Minimise urine sample contamination
Use of sterile catheter samples
Midstream sample of urine
Most causative organism of UTI in pregnancy
E coli 80-90%
2nd: staph saprophyticus
GBS
Sequelae of asymptomatic bacteruria
Cystitis - up to 30%
Pyelonephritis - up to 50%
Screening tests for asymptomatic bacteruria
Routine MSSU screening in early pregnancy
If positive; follow up cultures
Presence of nitrites in urine of symptomatic women suggests
Strongly suggests significant bacteruria -> final diagnosis with quantitative urine culture
Anyibiotic regimen in asym. Bacteruria, pyelonephritis and cystitis
- Asymptomatic bacteriuria: 1w
- A. Pyelonephritis: 3 w
- Cystitis: 7-10 days
1st line ttt of acute cystitis
Increasing oral fluid intake
Symptoms of cystitis
Dysuria
Frequency
Urgency
Suprapubic pain
The diagnostic gold standard im pyelonephritis
Renal biopsy but it is impractical
Management of pyelonephritis
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
What cases we avoid NSAIDs
- CKD
- PET
- OHSS
- SCD (12-31w)
Analgesia accepted in renal diseases
paracetamol and opioids
Avoid NSAIDs
NSAIDS effect on pregnancy
Oligohydramnios
Premature ductus arteriosus closure
Gastric ulcer
Renal perfusion
The most common reason for initial ttt failure in pyelonephritis
- AMR
- underlying pathology or renal tract anomaly
- renal calculi
What is recurrent UTI
3 UTI on a year
Or
2 UTI IN 6 months
Prevention of RUTI in pre and postmenopausal women
Pre MP: glycosaminoglycan
Post MP: Estrogen
What test we use to assess renal function in pregnancy
S. creatinine (don’t use GFR)
Do s creatinine level is the same during pregnancy
It falls be 35 ug/ l in pregnancy
From 80 to 53
If >90 diagnostic of AKI IN pregnancy
Renal changes during pregnancy
- GFR INC -> so s. Creatinine and urea falls
- Renal plasma flow inc in 1st and 2nd, falls in 3rd
- Proteinuria common but not >300mg/24 hrs
Most common cause of AKI in pregannxy
Preeclampsia
Percentage of cases of AKI passed undiagnosed in pregnancy
40%
Indications for renal replacement therapy in AKI
Severe AKI Irresponsive to ttt
CKD w/ superimposed AKI
Metabolic alkalosis
Urea >17 mmol/l is teratogenic
Hyperkalemia -> give calcium salt for cardiac stability
Magnesium sulphat in PE and AKI
It is renal exerted.
A loading dose 4g over 5-15 mins
Maintenance dose reduced: 0.5 g/hr
IV HYDRATION IN PET women
Associated witg pulmonary edema
She must be kept dry
80ml/hr is recommended peripartum
What is thrombotic microangiopathy
TTP (neuro sym) AND HUS (renal sym)
thrombi in the microvasculature lead to consumptive thrombocytopenia, hemolysis and end organ damage
Pathology of TTP
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
Rate of AKI with TTP
AKI occurs in 30-80% of pregnancy related TTP
Much higher than TTP outside pregnancy
Pathology of HUS
Pathological over-activation of complement leads to endothelial damage and renal injury
HUS PROGNOSIS
Autosomal recessive HUS:
- occurs in childhood
- poor prognosis
- frequent recurrence
- mortality rate 60-70%
Autosomal dominant HUS:
- adults
- poor prognosis
- mortlaity rate: 50-90%
When pregnancy related HUS usually occur
Postpartum, when placental expression of complement regulatory proteins is lost
Management of HUS/TTP
FFP infusion
Eculizumab (if adam13 <10%)
