Renal_Failure_in_Pregnancy

Renal_Failure_in_Pregnancy - Renal Failure and Dialysis in...

Info iconThis preview shows pages 1–12. Sign up to view the full content.

View Full Document Right Arrow Icon
Renal Failure and Dialysis in Pregnancy David Shure
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Differential Diagnosis 1. FSGS - Pro: HTN, non-remitting, albumin close to NL Con: expected creatinine to be higher after several years 2. Membranous Nephropathy - Pro: wax/waning course Con: often with lower albumin, edema 3. Diabetic Nephropathy - Pro: proteinuria, time course Con:poor evidence for DM 4. FMD - Pro: unequal sized kidneys, young female, HTN hx, renal arteries not commented on in US
Background image of page 2
Nephrology Consult 1. Is there any indication and/ or benefit to the fetus if we begin HD at this time? 2. Can we preserve any residual maternal renal function? OB team trying to prolong in-utero growth/ length of pregnancy, not sure if pt is masking severe preeclampsia
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Why did Ob Deliver the Baby? 7/21 pt c/o HA, and 7/23 severe RUQ tenderness and epigastric pain, decision made to deliver fetus based on: Severe superimposed Preeclampsia in setting of chronic HTN Also, mild thrombocytopenic further led to diagnosis of severe preeclampsia
Background image of page 4
Normal Physiologic Alterations of Pregnancy
Background image of page 5

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Normal Renal Alterations in Pregnancy
Background image of page 6
Changes in GFR GFR and RBF rise markedly Glomerular hyperfiltration results in normal reduction in the plasma creatinine concentration to about 0.4 to 0.5 mg/dL Blood urea nitrogen (BUN) and uric acid levels fall for the same reason
Background image of page 7

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Effects of Pregnancy on Renal Disease 1. ½ cases proteinuria worsen 2. ¼ cases HTN develops 3. Worsening edema if nephrotic 4. 0-10% women with NL or mild reduction in GFR have permanent decline in renal function
Background image of page 8
Views on Pregnancy and Dialysis ‘Children of women with renal disease used to be born dangerously or not at all - not at all if their doctors had their way’, Lancet, 1975 ‘Show me a method of birth control more effective than end stage renal disease’, Roger Rodby MD, 1991 ‘Even if a woman on CAPD ovulates, doesn’t the egg just float away?’, Rodby, 1992
Background image of page 9

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Why don’t uremic women get pregnant? Most beyond child bearing age Libido/ frequency of intercourse reduced Don’t ovulate Absence of increase in basal body temperature during the luteal phase of cycle Elevated circulating prolactin concentrations Elevated PRL impairs hypothalamic-pit function
Background image of page 10
Actually, they do get pregnant! 1st successful term pregnancy in 35 y/o dialysed
Background image of page 11

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full DocumentRight Arrow Icon
Image of page 12
This is the end of the preview. Sign up to access the rest of the document.

This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

Page1 / 42

Renal_Failure_in_Pregnancy - Renal Failure and Dialysis in...

This preview shows document pages 1 - 12. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online