UW kidney. normal renal/hydronephr. 02-13 (1) Flashcards
During pregnancy, kidney enlargement occurs because ……?
an increase in maternal blood volume that requires increased renal filtration, resulting in greater renal vasculature and interstitial tissue.
when begins hydronephrosis?
in first trimester;
more pronounced in 2nd and 3rd
mechanism behind hydronephrosis?
high progesterone levels cause ureteral dilation and decreased peristalsis.
why hydronephrosis more pronounced in 2nd-3rd trimesters?
as uterine enlargement compresses the ureters at the pelvic brim, which results in dilation of the proximal ureters and bilateral hydronephrosis.
physiologic hydronephrosis Mx?
requires no additional management.
pvz vienas inktas uz kita didesnis nes slapimo pusle gali labiau spausti desini slapimtaki ties pelvic brim
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so in general: Hydronephrosis in pregnancy occurs due to ureteral compression from uterine enlargement and decreased ureteral peristalsis due to increased progesterone.
in UG right>left kidney
what pathologies are Tx with Foley?
bladder outlet obstruction.
Symptoms:decreased urination
in pregnancy hydronephrosis - frequent urination
when is performed Urodynamic testing?
to evaluate mixed urinary incontinence outside of pregnancy.
Urinary frequency and nocturia are normal in pregnancy due to bladder compression by the uterus and nighttime shifting of edema back into circulation.
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when are performed Ureteral stents and nephrostomy ?
when the etiology of hydronephrosis is ureteral blockage (eg, nephrolithiasis).
Obstruction usually presents with microscopic hematuria and unilateral imaging findings (eg, visible stone, unilateral hydronephrosis).
dor Ureteral stents /nephrostomy
normal physiologic changes. 3?
Incr. renal blood flow
incr. GFR
incr. Renal basement membrane permeability
Lab findings in normal renal changes. 3
decr. Serum BUN
decr. serum creat
incr. renal protein excretion
cardiac output and blood volume increase because the cardiovascular system -> renal system experiences greater renal blood flow (perfusion) and individual glomeruli filter greater volumes of plasma (ie, increased glomerular filtration rate).
production of BUN and Cr relatively same, but due to incr. filtration, levels of these are decreased.
normal Cr in pregnant?
normal: 0.4 to 0.8 mg/dL).
what Cr level is normal in nonpregnant, but abnormal in pregnant?
1,2 mg/dL - upper limit in nonpregnant. But indicated insuff. in pregnant
An additional renal adaptation in pregnancy is greater renal basement membrane permeability, resulting in increased urinary protein excretion.
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Due to the increase in renal function during pregnancy, patients on medications that are renally excreted require close monitoring and dose adjustments as necessary.
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Increased urinary protein excretion of up to 300 mg/day occurs in pregnancy due to increased renal basement membrane permeability.
Therefore, urine dipsticks positive for trace protein are normal in pregnancy.
During pregnancy, total blood volume expands. However, plasma volume increases out of proportion to red blood cell mass, causing a mild physiologic decrease in hemoglobin concentration. Laboratory definitions for anemia vary by trimester: <11 g/dL in the first and third trimesters and <10.5 g/dL in the second trimester. This dilutional anemia protects the mother in case of postpartum hemorrhage.
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