{"id":8109,"date":"2021-11-15T22:59:47","date_gmt":"2021-11-15T20:59:47","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/nephrology\/pregnancy-and-the-kidney-hypertensive-disorders-in-pregnancy\/"},"modified":"2021-11-22T08:12:47","modified_gmt":"2021-11-22T06:12:47","slug":"pregnancy-and-the-kidney-hypertensive-disorders-in-pregnancy","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/pregnancy-and-the-kidney-hypertensive-disorders-in-pregnancy\/","title":{"rendered":"Pregnancy and the kidney, hypertensive disorders in pregnancy"},"content":{"rendered":"\n<ul class=\"wp-block-list\"><li>Increase in the volume and size of the renal system:<ul><li>Kidney parenchyma<\/li><li>Ureter caliber (This may lead to <strong>reflux and UTIs<\/strong>)<\/li><\/ul><\/li><li>Increase in renal blood flow and GFR<\/li><li>Changes in tubular function<ul><li>Decreased serum osmolality and sCr<\/li><li>Increased urinary glucose, bicarbonate, calcium, protein content<\/li><\/ul><\/li><li>Increase in sodium retention leading to water retention, which is crucial for the increase in plasma volume<\/li><li><strong>Physiologic hydronephrosis<\/strong><\/li><li><strong>Decrease in BP<\/strong> in 1-2nd trimesters (due to decreased vascular resistance), <strong>increase in CO<\/strong>, and <strong>increase in RAAS<\/strong> activity<\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Pregnancy and AKI<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">The most common cause for AKI in pregnancy is pre-eclampsia (intra-renal AKI).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other pregnancy-related causes include excessive vomiting and postpartum hemorrhage (pre-renal AKI).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Management is similar to normal AKI.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Pregnancy and CKD<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The physiologic changes are lacking in CKD. Diabetic nephropathy is the most common cause of CKD.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">CKD is associated with a much higher risk for pre-eclampsia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Special care should be given to such pregnancies, with a <strong>multidisciplinary team<\/strong> on-board (MDT approach), with frequent monitoring, and a special focus on renal function, hypertension, and proteinuria.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Pregnancy and renal transplantation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Pregnancy should be avoided for at least one year after transplantation. Immunosuppressive drugs should be evaluated for teratogenicity. Prednisolone, azathioprine, ciclosporin or tacrolimus are safe in pregnancy.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Hypertension and pregnancy<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">HTN is seen in 10% of pregnancies; it can be described based on the timeframe of appearance:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Chronic HTN (HTN present before pregnancy)<\/li><li>Gestational HTN (new onset of HTN during pregnancy)<\/li><li>Pre-eclampsia (HTN [140\/90] with proteinuria [&gt;300mg\/day] after 20th week of gestation)<\/li><li>Eclampsia (unexplained generalized seizures in patients with preeclampsia)<\/li><li>Superimposed preeclampsia (chronic HTN + pre-eclampsia)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Mechanism of pre-eclampsia<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Theorized to begin with placental vasoconstriction and hypoperfusion (due to endothelial dysfunction caused by reduced NO production and decreased antioxidant activity)<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Placental damage and release of trophoblastic material into the circulation causing DIC<\/li><li>Renal damage leading to reduced GFR, sodium and fluid retention, and later on AKI<\/li><li>The fluid retention is actually extravascular, and the sodium excess leads to hypersensitivity to vasoconstriction<\/li><li>Further vasoconstriction, placental infarctions, leading to a vicious cycle<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Symptoms<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li>Headache<\/li><li>Visual disturbances\/flashing lights<\/li><li>Epigastric pain<\/li><li>Nausea and vomiting<\/li><li>Edema (face and limbs)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Other manifestations<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Pulmonary edema<\/li><li>Cerebral hemorrhage<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">HELLP syndrome<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">A severe manifestation of pre-eclampsia occurring during a severe DIC phase. <strong>Hemolysis, Elevated Liver enzymes, Low Platelets.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Schistocytes (helmet cells)<\/li><li>ALT and AST elevation<\/li><li>Low platelet due to the rapid DIC<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Risk factors<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li>Nulliparity<\/li><li>Older age<\/li><li>Obesity and diabetes<\/li><li>Pre-existing HTN<\/li><li>CKD<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment of eclampsia<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li>Magnesium sulfate (for the seizures)<\/li><li>Delivery<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Antihypertensive therapy in pregnancy<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Methyldopa (a2-agonist)<\/li><li>Prazosin (a1-antagonist)<\/li><li>Labetalol (combined a1 and BB)<\/li><li>Nifedipine (CCB)<\/li><li>Hydralazine (vasodilator)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">References: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5873710\/<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pregnancy and AKI<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pregnancy and CKD<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pregnancy and renal transplantation<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Hypertension and pregnancy<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Mechanism of pre-eclampsia<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Symptoms<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Other manifestations<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">HELLP syndrome<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Risk factors<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment of eclampsia<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Antihypertensive therapy in pregnancy<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Increase in the volume and size of the renal system: Kidney parenchyma Ureter caliber (This may lead to reflux and UTIs) Increase in renal blood flow and GFR Changes in tubular function Decreased serum osmolality and sCr Increased urinary glucose, bicarbonate, calcium, protein content Increase in sodium retention leading to water retention, which is crucial [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":685,"menu_order":11,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8109","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Pregnancy and the kidney, hypertensive disorders in pregnancy &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/nephrology\/pregnancy-and-the-kidney-hypertensive-disorders-in-pregnancy\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" 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