ACUTE RENAL FAILURE IN PREGNANCY

Posted by e-Medical PPT Saturday, October 6, 2012
Overview
BASIC OUTLINE
Investigations
MANAGEMENT PRINCIPLES
Prerenal  Vs  ATN  Vs  ACN
ROLE OF     Nutrition
                  Volume & metabolic control
                  Diuretics : helpful or harmful ??
                  Dopamine : helpful or harmful ??
                  Dialysis :  when & which ??
                  Renal biopsy ??
                  Delivery
                 
Conditions specific to pregnancy

DEFINITIONS OF ARF
The syndrome is characterised by a sudden     in parenchymal function (UOP<400ml/d;30ml/hr) which is usually but not always reversible
This produces disturbance of water, electrolyte, acid base balance and nitrogenous waste products & blood pressure.

Physiological changes in normal gestation
Kidney weight and size increase
Dilation of renal calyces, pelves, and ureters
Urinary stasis
Glomerular filtration, effective renal plasma flow,  fractional clearance of urate increase
Bicarbonate reabsorption threshold decreases

Clinical relevance
Concentrations of serum creatinine, urea N, and uric acid of 0.9, 14, and 5.6 mg/dl, normal in nonpregnant subjects, are already suspiciously high in gravid women.
Asymptomatic bacteriuria - frank pyelonephritis.
 PP reduction in size should not be mistaken for parenchymal loss
Post renal failure difficult to diagnose
S.bicarb lower,PCO2 10 mmHg lower

Causes
Bimodal distribution -peaks in the first trimester (related to unregulated and/or septic abortion,hyperemesis) and the late third trimester (related to obstetric complications APH,PPH,Preeclampsia, Chorioamnionitis,AFE etc).

Delivery
Development of ARF in obs pt is indication of delivery in majority cases.
Deliver if UOP<20 ml/>2hrs despite adequate vol expansion & immediate delivery not expected
Redistribution of CO – better renal perfusion.
Remove fetus from hostile environment.
Neonate Increased [urea] –osmotis diuresis -dehydration
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