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Pregnancy and kidney disease: case studies

Pregnancy and kidney disease: case studies. Matt Hall May 28 th 2009. Why is it important to know about pregnancy and kidney disease?. It’s means a lot for a small number of people. It can be very scary if you don’t know what you’re doing. It’s in the exam. Loads!.

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Pregnancy and kidney disease: case studies

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  1. Pregnancy and kidney disease: case studies Matt Hall May 28th 2009

  2. Why is it important to know about pregnancy and kidney disease? • It’s means a lot for a small number of people. • It can be very scary if you don’t know what you’re doing. • It’s in the exam. Loads!

  3. What do you need to know? Blood pressure and treatment Serum creatinine Presence of UTI Proteinuria Past obstetric history Medication

  4. Management interventions Aspirin Treat blood pressure Treat infection LMWH Dialysis Deliver baby

  5. Case 1 • Age 34. Primigravida. • Renal transplant 2001 – ESRD ?cause • Attended pre-conception counselling 4 months before conception

  6. Case 1 - baseline Blood pressure and treatment BP 100/60 on no Rx prior to conception Serum creatinine Creatinine 122μmol/l (eGFR 44ml/min), stable Presence of UTI No history of recurrent UTI Proteinuria PCR 23 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine

  7. Case 1 – at booking Didn’t realise she was pregnant until 22 weeks

  8. Case 1 – 24 weeks Blood pressure and treatment BP 162/102 Methyldopa Serum creatinine Creatinine 90μmol/l Presence of UTI No UTI Proteinuria PCR 66 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine

  9. Case 1 – 28 weeks Blood pressure and treatment BP 139/84 Serum creatinine Creatinine 103 μmol/l Presence of UTI No UTI Proteinuria PCR 69 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine, methyldopa

  10. Case 1 – 32 weeks Blood pressure and treatment BP 141/83 Serum creatinine Creatinine 95 μmol/l Presence of UTI No UTI Proteinuria PCR 115 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine, methyldopa

  11. Case 1 – 35 weeks Blood pressure and treatment BP 118/82 Serum creatinine Creatinine 112 μmol/l Presence of UTI No UTI Proteinuria PCR 138 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine, methyldopa

  12. Case 1 – 37 weeks Blood pressure and treatment BP 139/84 Serum creatinine Creatinine 121 μmol/l Presence of UTI No UTI Proteinuria PCR 69 mg/mmol creatinine Past obstetric history Not applicable Medication Prednisolone, tacrolimus, azathioprine, methyldopa

  13. Case 1 – 39 weeks Blood pressure and treatment BP 149/95 Serum creatinine Creatinine 141 μmol/l Presence of UTI No UTI Proteinuria PCR 111 mg/mmol creatinine Past obstetric history Not applicable Induction Medication Prednisolone, tacrolimus, azathioprine, methyldopa

  14. Outcome Weight: 3.25kg Apgar: 101 and 105 Status: Alive and well

  15. Outcome Acute rejection

  16. Case 2 • 23 year old. Primigravida. • Type 1 DM. • Retinopathy.

  17. Case 2 – baseline Blood pressure and treatment BP ?: no Rx Serum creatinine Creatinine 84μmol/l (eGFR 78 ml/min) Presence of UTI No history of recurrent UTI Proteinuria Not recorded – no known h/o proteinuria Past obstetric history Not applicable Medication Insulin, lamotrigine Aspirin

  18. Case 2 – 20 weeks Blood pressure and treatment BP 107/62: no Rx Serum creatinine Creatinine 85μmol/l Presence of UTI No UTI Proteinuria PCR 331 mg/mmol creatinine Past obstetric history Not applicable Medication Insulin, lamotrigine, aspirin LMWH

  19. Case 2 – 22 weeks Blood pressure and treatment BP 121/69: no Rx Serum creatinine Creatinine 85μmol/l Presence of UTI No UTI Proteinuria 4.14g/24h. Albumin 32g/dl. Oedema. Past obstetric history Not applicable Medication Insulin, lamotrigine, aspirin, LMWH

  20. Case 2 – 28 weeks Blood pressure and treatment BP 126/82: no Rx Serum creatinine Creatinine 71 μmol/l Presence of UTI No UTI Proteinuria 5.53g/24h. Albumin 33g/dl. Past obstetric history Not applicable Medication Insulin, lamotrigine, aspirin, LMWH

  21. Case 2 – 34 weeks Blood pressure and treatment BP 104/65: no Rx Serum creatinine Creatinine 77 μmol/l Presence of UTI No UTI Proteinuria PCR 683 mg/mmol. Albumin 32g/dl. Past obstetric history Not applicable Medication Insulin, lamotrigine, aspirin, LMWH

  22. Case 2 – 37 weeks Blood pressure and treatment BP 119/71: no Rx Serum creatinine Creatinine 81 μmol/l Presence of UTI No UTI Proteinuria PCR 622 mg/mmol. Albumin 34g/dl. Past obstetric history Not applicable Induction at 38 weeks Medication Insulin, lamotrigine, aspirin, LMWH

  23. Outcome Weight: 3.32kg Apgar: 91 and 95 Status: Alive and well

  24. Outcome

  25. Outcome

  26. Case 3 • 29 year old. G2 P1+0 • IgA nephropathy diagnosed following first pregnancy

  27. Case 3 - baseline Blood pressure and treatment BP 105/70 prior to conception Serum creatinine Creatinine 91μmol/l (eGFR 66ml/min) Presence of UTI No history of recurrent UTI Proteinuria PCR 175 mg/mmol creatinine Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication Ramipril

  28. Case 3 – 10 weeks Blood pressure and treatment BP 144/90 Serum creatinine Creatinine 85μmol/l Presence of UTI No UTI Proteinuria PCR 393 mg/mmol creatinine but 1.9g/d. Albumin 29 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication

  29. Case 3 – 12 weeks Blood pressure and treatment BP 150/99 but good 24h BPM Serum creatinine Creatinine 85μmol/l Presence of UTI No UTI Proteinuria PCR 353 mg/mmol creatinine. Albumin 28 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication LMWH

  30. Case 3 – 22 weeks Blood pressure and treatment BP 132/85 Serum creatinine Creatinine 103μmol/l Presence of UTI No UTI Proteinuria PCR 241 mg/mmol. Albumin 27 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication LMWH

  31. Case 3 – 27 weeks Blood pressure and treatment BP 138/87 Serum creatinine Creatinine 123 μmol/l Presence of UTI No UTI Proteinuria PCR 444 mg/mmol. Albumin 23 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication LMWH

  32. Case 3 – 32 weeks Blood pressure and treatment BP 127/76 Serum creatinine Creatinine 107 μmol/l Presence of UTI No UTI Proteinuria PCR 680 mg/mmol. Albumin 22 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication LMWH Admit 3x/wk visits Evidence of poor fetal growth

  33. Case 3 – 34 weeks Blood pressure and treatment BP 131/71 Serum creatinine Creatinine 125 μmol/l Presence of UTI No UTI Proteinuria PCR 708 mg/mmol. Albumin 25 g/dl Past obstetric history Nephrotic from 20 weeks. Pre-eclampsia at 35 weeks. Medication LMWH Elective CS at 35+5/40

  34. Outcome Weight: 1.75kg Apgar: 91, 105 Status: Alive and well

  35. Outcome Renal biopsy

  36. Summary • Stats say that adverse maternal and fetal outcome depends on: • blood pressure • baseline creatinine • Patients don’t often read the stats

  37. Summary Aspirin Treat blood pressure Treat infection LMWH Deliver baby

  38. http://renal.pinetreeavenue.com • Soon to be changed to: http://www.emidsrenaltraining.org.uk Work in progress

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