Renal System in Pregnancy

Question 1

What is the renal system made up of?

Answer 1

• 2 kidneys
• 2 ureters
• Bladder
• Urethra

Question 2

What are the changes in pregnancy that cause changes in the renal system?

Answer 2

• Increased waste
• Increased cardiac output and blood volume
• Progesterone and relaxin
• Enlarging uterus

Question 3

What changes occur to the nephron in pregnancy?

Answer 3

• More fluid reabsorbed
• Blood flow increased
• Vasodilation
• GFR increases by 50%
• 25% increase in urine output

Question 4

What changes occur to the bladder in pregnancy?

Answer 4

• Capacity doubles to 1L
• Increased blood supply
• Increased oedema = risk of infection
• Decreased tone

Question 5

What effect does decreased bladder tone have?

Answer 5

Causes an increased risk of urinary reflux and incomplete emptying, which can cause UTIs

Question 6

What is AKI?

Answer 6

Acute Kidney Injury = Sudden episode of kidney failure/ damage, resulting in inability to remove waste and maintain fluid balance

Question 7

What are the stages of AKI?

Answer 7

1 = urinary output <0.5ml/kg/hr for >6 hours
2 = urinary output <0.5ml/kg/hr for >12 hours
3 = urinary output <0.5ml/kg/hr for >24 hours (or 12 hours anuria)

Question 8

What are the clinical signs of AKI?

Answer 8

• Creatinine >77
• Increased creatinine by 26+
• Urinary output <20ml/hr for 12 hours

Question 9

What investigations should be done if AKI is suspected?

Answer 9

• Urgent PCR
• USS - check for obstruction
• Us&Es and LFTs

Question 10

What other monitoring should take place if AKI is suspected?

Answer 10

• Monitor for sepsis (obs)

- Catheterise + fluid balance

Question 11

What fluids should be given for someone with suspected AKI?

Answer 11

250ml bolus and then 125ml/hr of crystalloid