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Obs (renal disorders in pregnancy)
1.
2. Physiological Adaptation
Dramatic dilatation of the urinary collecting system
during pregnancy.
Renal plasma flow rises by 60-80% by the second
trimester.
RPF falls throughout the third trimester but
maintained at 50% greater than prepregnancy levels.
GFR increases significantly and creatinine clearance
rises by 50%.
Fall in Urea and Creatinine level
Pretein excretion is increased up to 300 mg per 24
hours.
80% of women develop edema due to physiological
increase in sodium retention.
4. Asymptomatic Bacteriuria
Incidence
This ranges from 2 to 10%
40% will develop symptomatic urinary-tract
infection in pregnancy.
Women with history of previous urinary-tract
infection have a 10-fold increased risk of
developing cystitis or acute pyelonephritis in
pregnancy.
5. Pathogenesis
75-90% due to E coli, probably derived from large bowel
Colonization of urinary tract results from ascending
infection from the perineum and is related to sexual
intercourse.
Diagnosis
Most women with asymptomatic bacteriuria are found to
be infected during early pregnancy and very few
subsequently acquire asymptomatic bacteriuria
Bacteriuria is only considered significant if the colony
count exceeds 100,000/ml on a MSU
6. Management:-
The choice of antibiotic depends on
culture/sensitivity
Ampicillin, amoxicillin, Augmentin and the
cephalosporin are safe and appropriate
antibiotics in pregnancy.
Treatment should be continued for 2 weeks in
the first instance and regular urinary culture
required.
8. Management:-
Same as asymptomatic bacteriuria
Several non-pharmacological maneuvers may
help to prevent recurrent infection in women
with recurrent urinary-tract infections in
pregnancy.
These include:
Increase fluid intake
Emptying the bladder following sexual
intercourse
9. Acute Pyelonephritis:-
Incidence
This complicates 1-2% of pregnancies
More common in pregnancy ( physiological dilatation of the
upper renal tract).
Clinical Features
Fever
Loin and abdominal pain
Vomiting
Rigors
Proteinuria
Haematuria
10. Risk increases in women
On steroid therapy
With polycystic kidneys
Congenital abnormalities of renal tract
Urinary-tract calculi
Diabetes
12. Management:-
Intravenous fluid for adequate hydration
(crystalloids).
I/V Antibiotic Penicillin and cephalosporin are the Ist
choice.
Evaluate hemogram, serum electrolytes, creatinine
Antimicrobial supression therapy is continued till the
end of pregnancy to prevent recurrence.
Nitrofurantoin 100 mg daily at bed time is effective.
14. Pregnancy with Chronic Renal Disease :-
Effects of Pregnancy
The risks include:
Accelerated decline in renal function
Rising hypertension
Worsening proteinuria
15. Effects of chronic renal disease on pregnancy
The risks includes:
Miscarriage
Pre-eclampsia
Intrauterine growth retardation
Preterm delivery
Fetal death
16. Factors Influencing Outcome:-
The presence and degree of renal impairment
The presence and severity of proteinuria
The underlying type of chronic renal disease
19. Management :-
24 hours urine collection is done for creatinine clearance
and total proteinuria.
Antihypertensive drugs is started
early(Nifedipine,hydralzine) to preserve renal function.
Diuretics may be used in cases of severe edema.
Regular hemodialysis during pregnancy in patient with
moderate renal compromise may improve the outcome.