Lupus Nephritis in Pregnancy - final

Lupus Nephritis in Pregnancy - final - LupusNephritisin...

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Lupus Nephritis in Pregnancy Nicola Sumorok Nephrology Grand Rounds, August 16 th , 2011
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Outline Normal physiology of pregnancy CKD in pregnancy Lupus nephritis in pregnancy Pre eclampsia
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Normal Physiology of Pregnancy Kidneys play a major role in adapting to pregnancy and needs of the fetus Renal hemodynamic adjustments: Marked vasodilation decrease in BP Increase in RBF by up to 80% above baseline Increase in GFR by about 50% Retention of Na (about 900 mEq) increased plasma volume Stimulation of RAS system – maintains BP Increased CO from decreased afterload and increased HR Overall increase in size of the kidneys by 1 1.5cm
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Normal Physiology of Pregnancy Nonhemodynamic Alterations: Progesterone stimulates meduIlary respiratory center Increase in RR and TV respiratory alkalosis (dec PCO2) Partially compensated, resulting in low serum bicarbonate Lower osmotic threshold for thirst and ADH release lower serum osm and Na concentration
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Normal Physiology, in Summary… The renal adaptation to pregnancy is critical to ensure appropriate volume expansion and increased perfusion to meet the needs of the developing fetus and placenta. Vasodilation, lower blood pressure, and increased cardiac output are the most obvious consequences of this process. Theoretically, the adaptive physiologic changes in pregnancy (especially increased GFR and Renal plasma flow) render a woman with renal disease vulnerable to deterioration
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CKD in Pregnancy
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Jones, et al 82 pregnancies in 67 women with primary renal disease Cr > 1.4 prior to pregnancy or 1 st antepartum visit 90% with known chronic GN or chronic tubulointerstitial disease Jones D, Hayslett J. Outcome of Women in Pregnancy with Moderate or Severe Renal Disease. NEJM, 1996; 335: 226 232.
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Results Jones D, Hayslett J. Outcome of Women in Pregnancy with Moderate or Severe Renal Disease. NEJM, 1996; 335: 226 232.
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Trends in Serum Cr Jones D, Hayslett J. Outcome of Women in Pregnancy with Moderate or Severe Renal Disease. NEJM, 1996; 335: 226 232.
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Renal function 6 months post‐partum Jones D, Hayslett J. Outcome of Women in Pregnancy with Moderate or Severe Renal Disease. NEJM, 1996; 335: 226 232.
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Outcomes and Neonatal Complications Jones D, Hayslett J. Outcome of Women in Pregnancy with Moderate or Severe Renal Disease. NEJM, 1996; 335: 226 232.
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In Summary… HTN and high grade proteinuria were maternal complications in women with moderate to severe renal insufficiency Pregnancy related loss of renal function in nearly 50% of the women 10% had rapid progression to ESRD within 6 months after
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Lupus Nephritis in Pregnancy - final - LupusNephritisin...

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