Renal disorders Flashcards

1
Q

A creatinine above __ places pt at risk for progressive renal deterioration

A

About 10% of women with a Cr >/= 1.4 mg/dL will have progressive renal deterioration.

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

What Cr is considered a pregnancy contraindication?

A

> 2.3 mg/dL

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

Preconception counseling for renal txplant pts

A

Wait one to two yrs post txplant before attempting pregnancy, overall live birth rate of >90%. Nl BP (diastolic < 90) ideal, or controlled on just one agent.

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

What therapy may reduce preeclampsia risk in women with mod-severe renal insufficiency?

A

Low dose aspirin

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

Definition of nephrotic syndrome

A

> 3.5 grams proteinuria in nonpregnant adults

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

Live birth rate in lupus nephritis

A

Pts do well when in remission for 6 months prior to conception, with live birth rate up to 95%

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

Predictors of adverse outcomes in lupus pts

A

Low complement levels at conceptionRisk of flare incr w/ >1 gram proteinuria or GFR < 60 mL/min

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

Permanent decline in renal function

A

In pts with mod-severe insufficiency (Cr >1.4), deterioration seen in 43%, of which 10% do not improve postpartum.

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

Cr < 1.4, rate of complications

A

PTB 20%Preeclampsia 11%HTN 25%FGR 24%Perinatal mortality 9%Live birth > 90%Decline in renal function 16%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cr 1.4 - 2.8, rate of complications

A

PTB 36-60%Preeclampsia 42%HTN 56%FGR 31-37%Perinatal mortality 7%Live birth > 90%Decline in renal function 50%

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

Cr >2.8, rate of complications

A

PTB 73-86%Preeclampsia 86%HTN 56%FGR 43-57%Perinatal mortality 36%Live birth N/ADecline in renal function 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dialysis, rate of complications

A

PTB 48-84%Preeclampsia 20%HTN 100%FGR 50-80%Perinatal mortality 60%Live birth 40-50%Decline in renal function N/APolyhydramnios 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Renal transplant, rate of complications

A

PTB 52-75%Preeclampsia 23-37%HTN 47-63%FGR 20-66%Perinatal mortality 7%Live birth 74-80%Decline in renal function 14%

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

Who should be prescribed ASA?

A

Low dose aspirin in pregnancy can improve outcome in patient with mod-severe CRI or hx lupus nephritis to reduce preeclampsia and FGR

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

Causes of nephrotic syndrome

A

MCC outside of pregnancy:Focal glomerulosclerosisMembranous nephropathyMinimal change diseaseIn pregnancy:Hydatidiform mole

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

Management of pregnancy in dialysis pts

A

Counseling regarding complicationsDiscuss termination, with better outcome p txplantHD 6-7x/wk (increase prepregnancy regimen by 50%)Plasma urea, predialysis, of 30-50 mg/dL (5-9 mmol/L) is assoc with improved outcomesPeritoneal dialysis not recommended, but if pt already established on PD, no need to change to HDLow BUN (7-10 mg/dL) to avoid fetal osmotic diuresisAvoid maternal HTN (keep BP 130-150/80-90)Avoid excessive fluid shiftsKeep bicarb 22-26, Hgb 11-12, replace Ca, PhosMaternal serum screening for aneuploidy is unreliableConsider delivery at 34-36w

17
Q

Goal immunosuppressant therapy in txplant patients

A

Maintenance levels:Pred < 15 mg/dAzathioprine < 2mg/kg/dCyclosporine <5 mg/kg/dTacrolimus crosses placenta, but no assoc w/ anomalies

18
Q

Management of pregnancy in transplant pts

A

Initial labs - CMV< toxo, HSV IgG/IgM, LFTsEarly 1 hr gtt if on prednisone or tacrolimusMonthly CBC, BUN, Cr, electrolytes, serum urate, 24 hr CrCl and protein, urine culture. Immunosuppressant levels q trimester

19
Q

Pyelonephritis rate w/ untreated ASB

A

24-40%, compared to 3% if treated

20
Q

Drug Interactions with Cyclosporine

A

There are many - look up before prescribing.A few common drugs:GentamicinVancomycinRanitidineBactrimFluconazole

21
Q

Classification of Renal Insufficiency (based on creatinine)

A

Serum creatinine in early pregnancy:Preserved < 1.1 mg/dLMildly impaired renal fxn 1.1-1.3 mg/dLModerate RI 1.4-2.8 mg/dLSevere RI >2.8 mg/dL

22
Q

Stages of Chronic Kidney Disease (based on GFR)

A

1 - Kidney damage w/ nl or incr GFR >/= 902 - Kidney damage w/ mildly decr GFR 60-893 - Mod decr GFR 30-594 - Severely decr GFR 15-295 - Kidney failure < 15 or dialysis

23
Q

Rate of allograft rejection in pregnant pts

A

6%

24
Q

How is creatinine clearance calculated?

A

(Urine creatinine x volume)/(serum creatinine x 1440 minutes)