Tog Flashcards
What is the prevalence of renal transplantation in UK?
2-6 /10 000
30- 40 pregnancies/ year
What is the risk of acute rejection of renal transplantation in the first year?
10- 15 % and is associated with recipients under the age of 45 years
What pregnancy counseling for renal transplant recipient 1 year after transplantation with normal eGFr?
Can be reassured that there is no conclusive evidence that pregnancy will increase their risk of graft rejection , or cause a deterioration in their graft function.
What medication should be stopped before pregnancy in renal transplant recipient? When? Why?
- Mycophenolate mofetil - can be switched to azathioprine
- 3 month
- 1- wash out period prior to pregnancy
2- allows confirmation of graft stability
3- can be used for prepregnancy folate administration ( 400 mcg/ d)
Among medications that commonly prescribed in solid organ transplant recipients … which is considered to be safe in breastfeeding?
Azathioprine
Cyclosporine
Tacrolimus
Hydroxychloroquine
Among medications that commonly prescribed in solid organ transplant recipients … which is considered to be teratogenic in pregnancy?
Mycophenolate
ACE inhibitors
Angiotensin receptor antagonist
Warfarin
What is the prevalence of hypertension among pregnant women with renal transplantat?
More than 50 %
In women with renal transplants who don’t require antihypertensives outside of pregnancy, how many of them will commence treatment for hypertension during pregnancy?
16 % of them
In renal transplant recipients which facilitates the detection of an increase in proteinuria after 20 weeks of gestation in the context of diagnosing PET?
Quantification of proteinuria in early pregnancy
What medications commonly prescribed in renal transplant recipients that have diabetogenic effects? What is the occurrence rate?
1- Calcineurin inhibitors ( tacrolimus- cyclosporine)
2- prednisolone
🔴 estimated to occur in 4- 25% of renal transplant recipients.
Why is CS rates higher in pregnant women with renal transplants ?
Consequence of PET and / or FGR
Leading to iatrogenic preterm delivery.
Is renal transplantation a contraindication to vaginal delivery?
No
Neonatal outcomes in women with renal transplants are a composite product of what?
PET / FGR / prematurity
What is the effect of renal transplantation on pregnancy?
1-⬆️ PET 30-40%
2-⬆️ CS
3-⬆️ neonatal unit admissions
4-⬆️ ectopic pregnancy
5-GDM
6- preterm delivery
7- ⬇️ birth weight
8- ⬇️ gestational age
9- infection: UTI 30-40%
What is the most common cause of creatinine rising in pregnant women with renal transplants?
PET
What is the rate of acute rejection during pregnancy in women with renal transplants?
In UK 2%
Meta-analysis 4.2%
What to do if graft rejection is suspected in pregnancy?
Graft biopsy
Less difficult than native biopsy
More bleeding in pregnancy
Transplant rejection can be treated in pregnancy with…..
1-Corticosteroid
2-Optimization of tacrolimus/cyclosporine
3- biological agents
What cautions should be taken about Babies exposed to biologic drugs in utero ?
Avoid live vaccines ( tuberculosis rotavirus- live attenuated influenza- oral polio - typhoid - yellow fever- varicella- measles- mumps- rubella)
🔴 during the first 6 months of life
In addition to routine first trimester investigations what to check in pregnant women with renal transplant recipients ?
CBC
Renal function / liver function
Ca / phosphate
Albumin
24h urine protein: cr ratio
Mid stream urine sample for culture
What to expect about proteinuria in pregnancy in women with renal transplants?
To double.
Further doubling if the woman was taking an ACEi ot ARA prior to pregnancy when these teratogenic drugs are discontinued.
When to consider LMWH prophylaxis in pregnant women with renal transplants?
Urinary protein: creatinine ratio
> 300 mg / mmol. ( Normal less than 15)
Or
Urinary albumin: creatinine ratio
> 180 mg / mmol (normal less than 3)
What to consider about serological screening for chromosomal trisomy in pregnant women with renal transplants?
There is a possibility of false positive result /affected by renal excretion of Bhcg./
What is the frequency of monitoring renal function during pregnancy in pregnant women with renal transplants?
Monthly
