The document discusses physiological changes during pregnancy that affect the kidneys. There is an increase in glomerular filtration rate and renal plasma flow by 50-60% due to rising plasma volume. Intraglomerular blood pressure remains unchanged despite these changes. Common renal complications in pregnancy include urinary tract infections, preeclampsia, acute renal failure, and renal calculi. Pregnancy poses risks but can be managed for women with pre-existing kidney disease through monitoring and adjusting treatment as needed.

2. & DR.A.NILAVAN PG II YEAR

4. Anatomic changes

7. TUBULAR CHANGES

8. Cont…. Pre-pregnancy Pregnancy Uric acid(mg/dl) 4 3.2 (early) 4.3 (late) Sodium(mmol/l) 140 135 Pottasium(mmol/l) Slight increase BUN(mg/dl) 12.7 9.3 Urea(mmol/l) 4.5 3.3 Vitamin/ amino acid decreases Protein(g/dl) 7 6(proteinuria) glucose glucosuria ca decreases Osmolality(mosm/kg) 285 275

9. Common changes in pregnancy Pre-pregnancy pregnancy Hematocrit% 41 33 Plasma protein(g/dl) 7 6 Plasma osmolality(mosm/kg) 285 275 Plasma sodium(mmol/l) 140 135 Plasma creatinine(mg/dl) 0.8 0.5 BUN(mg/dl) 12.7 9.3 Plasma urea(mmol/l) 4.5 3.3 pH 7.40 7.44 PCO2(mmhg) 40 30 Hco3(mmol) 25 20 SBP(mmhg) 115 105 DBP(mmhg) 70 60

15. Safety of antibiotics category Antibiotic A. Drugs taken by large no of pregnant women with out any proven harm Amox, ampi,cefalexin, Cephalothin,nitrofurantoin,penicillin B1 Taken by limited no of pregnant women with out proven harm; animal studies show no increase in fetal harm Aztreonam, ceftazidime,cefataxime, cefaclor, amox/clavulanic acid,piperacillin B2 As B1, but animal data unavailable Vancomycin B3 As B1,but animal studies show an increase in fetal damage Cipro, norfloxacin, ofloxacin,imipenem, Trimethoprim C Drugs whose pharmalogic effects are suspected of causing harm Sulphonamides, Cotrimoxazole, fusidic acid D Proven to cause fetal harm Tetracycline, gentamycin, Chloramphenicol

16. HYPERTENSION

19. Severe preeclampsia BP 160/110 Urine PC ratio >5 μ g/mg or proteinuria >5g/24 h urine Oliguria CVA , seizures, visual disturbance Pulmonary edema Epigastric or rt upper quadrant pain Hepato cellular injury Sr LDH >600 iu/l Thrombocytopenia < 100000(HELLP syndrome) IUGR

22. Management of preeclampsia PROBLEM MANAGEMENT Control blood pr Acute Rx if BP >170/110 Chronic Rx if BP>140/90 Eclampsia Diazepam 10-20mg to terminate convulsion Magnesium sulfate for neurological sign 4 g IV over 20 minutes then 1.5 g/hr for 48 hrs Volume expander therapy 500-1000 ml of colloid over 4-6 hr for persistent oliguria Supportive therapy Platelet infusion if count <20000-40000 FFP for micro angiopathy Dialysis for ARF Progressive decline in renal, hepatic or clotting function or fetal growth Delivery

23. Type of hyper tension drug Rx given Acute Hydralazine 5 mg bolus every20- 30 min (max 20 mg) then infusion at 5-10 mg/hr Labetolol 50 mg 20 every min (max 300mg) Nifidipine 20 mg oral Chronic first line Methyl dopa 500-2000mg/day PO Clonidine 0.2-0.8 mg /day PO Labetolol 200-1200mg/day PO Atenolol 50- 100 mg/day PO Second line Hydralazine 25-200 mg/day PO Prazosin 1-10 mg/day PO Nifidipine sr 40-100 mg/day PO

37. PREGNANCY WITH PRE-EXISTING KIDNEY DISEASE Effects on Renal disease Effects on Pregnancy outcome RENAL FUNCTION: Mild: Serum creatinine < 1.4 GFR >50 ml/min Mild/ no deterioration of renal function Preterm labour Moderate: Serun Creatinine 1.5-1.9 GFR 25-50ml/min 40% decline in renal function, but 50% will have recovery 2%----ESRD Preterm labour Preeclampsia IUGR Severe: Serum Creatinine >2 GFR <25ml/min 2/3----rapid decline 1/3-----ESRD Preterm labour Preeclampsia IUGR

39. MANAGEMENT OF WOMEN WITH CKD DURING PREGNANCY PREPREGNANCY Advise- Increased risk of Pregnancy complications |( IUGR, Preeclampsia,pretem labour) Adivise – increased risk of deteriorating maternal renal function Discontinue inappropriate medication- STATINS, ACE INHIBITORS, ARB Aspirin 75 m/dl Folic acid 5 mg/dl