The maternal renal system and adaptation

Question 1

Pregnancy

Answer 1

• Pre-existing renal conditions
• Frequency of micturition ( the action of urinating)
• Progesterone → smooth muscles relax
• Urinary tract infections
• Nocturia - wake up during the night because you have to urinate)
• Lowering of the renal threshold-glucose: the concentration level up to which a substance (as glucose) in the blood is prevented from passing through the kidneys into the urine.

Question 2

Labour

Answer 2

• Monitor urine output → should not decrease 30mls an hour
• Palpate for bladder before vaginal examination. Making sure they do not have a palpulate bladder → lost the urge of passing urine
• Epidural
• Capacity of bladder
• Retention of urine: as the bladder rises above the symphysis pubis leading to retention of the urethra
• Urinalysis
• Ketonuria: energy is needed during labour. The body uses up glucose and if not restored the body burns fat and a by-product of fat is ketone.

Question 3

Postnatal

Answer 3

• Increase in urine output as the woman is trying to try reverse and go back to normal for 7 days
• Retention of urine
• Stress incontinence
• Instrumental birth
• Urinary tract infections
• Acute renal failure
• Eclampsia

Question 4

Urinalysis

Answer 4

Acidity (pH). The pH level indicates the amount of acid in urine. Abnormal pH levels may indicate a kidney or urinary tract disorder.

Concentration. A measure of concentration, or specific gravity, shows how concentrated particles are in your urine. A higher than normal concentration often is a result of not drinking enough fluids.

Protein. Low levels of protein in urine are normal. Small increases in protein in urine usually aren’t a cause for concern, but larger amounts may indicate a kidney problem.

Sugar. Normally the amount of sugar (glucose) in urine is too low to be detected. Any detection of sugar on this test usually calls for follow-up testing for diabetes.

Ketones. As with sugar, any amount of ketones detected in your urine could be a sign of diabetes and requires follow-up testing.

Bilirubin. Bilirubin is a product of red blood cell breakdown. Normally, bilirubin is carried in the blood and passes into your liver, where it’s removed and becomes part of bile. Bilirubin in your urine may indicate liver damage or disease.

Evidence of infection. If either nitrites or leukocyte esterase — a product of white blood cells — is detected in your urine, it may be a sign of a urinary tract infection.
Blood. Blood in your urine requires additional testing — it may be a sign of kidney damage, infection, kidney or bladder stones, kidney or bladder cancer, or blood disorders.

Question 5

Urinary tract infections

Answer 5

Cystitis: caused by ascending infection, results in inflammation of the bladder causing voiding to be painful and frequent but with small quantities.

Urinary tract infections: an infection of kidneys and pelvis