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THE NORMAL AND DISEASED KIDNEY IN PREGNANCY

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THE NORMAL AND DISEASED KIDNEY IN PREGNANCY

اسلاید 1: IN THE NAME OF GOD

اسلاید 2: THE NORMAL AND DISEASED KIDNEY IN PREGNANCY

اسلاید 3: PREGNANCY-INDUCED CHANGES IN ANATOMYLength of kidneyLength of PTKidney volumeCapacity of the dilated renal collecting system

اسلاید 4: Pregnancy inhibits ureteral peristalsis ureteral hypomotility distention of ureterPregnancy mechanical obstruction ureteral distentionPregnancy smooth muscle relaxation VUREtiology of the UT dilatation in pregnancy Clinical relevance

اسلاید 5: CARDIOVASCULAR AND RENAL PHYSIOLOGY IN PREGNANCY PREGNANCY COP/ PVR / RVR / BP Blood volume /Na retention /Edema PREGNANCY RBF / RPF/ RVRClinical relevance

اسلاید 6: R-A-A-S in pregnancy Pregnancy R/ A/ PRA /Pro-REtiology : PGI2 Renin secretion Resistance to A2 Nepi/Avp

اسلاید 7: Renal tubular functionGTB in pregnancy (PT/DT)Normal Na balanceNormal water balance(ability to produce a maximally concentrated&maximally dilute urine24h urine volume Plasma Na level(5 meq/l ) Plasma osmolality (10 mosmol/kg h2o) Osmotic threshold for AVP release (285 276) Osmotic thirst threshold (290 280 )

اسلاید 8: Evaluation of renal function in pregnancy Examination of the urine :Pro/Alb/RBCCreatinin clearancePro/ CrCockroft-Gault formula

اسلاید 9: RENAL BIOPSY Sudden deterioration of renal function with no apparent causeSymptomatic NS

اسلاید 10: Theclinical spectrum&management of renal disorders in gestationPregnancy associated ARF Bimodal patternPre-renal Hyperemesis gravidarum BleedingPost-renal Stone/ TumorRenal ATN/ ACNPreeclampsia ATN HELLP SYN. ARF

اسلاید 11: MANAGEMENT OF ARF IN PREGNANCY

اسلاید 12: NEPHROLITHIASIS IN PREGNANCY FrequencyType of stoneDXTreatment

اسلاید 13: UTI IN PREGNANCY Prevalence (2-10% )Asymptomatic bacteriuria (6-7%)Acute pyelonephritis (20- 30%)Screening (16 W )Baceriuria post delivery (17%)Symptomatic infection(3%)Cystitis (./3 -1/3 %) Secound trimesterPyelonephritis (1-3%) 10% in early pregnancyManagement of UTI in pregnancy

اسلاید 14: RF for bacteriuria in pregnancy Previous history of UTI Multiparity Presence of HbSLower socioeconomic statusSexual activityDMAdvanced maternal age

اسلاید 15: PRE-EXISTING RENAL DISEASE Normotensive women with intact or only mildly decrease and stable renal function(Cr<1/4mg/dl ) Live birth :95% Frequeency of preeclampsia /HTN /Proteinuria in late pregnancy Exception :LN/ MPGN /SS / PAN

اسلاید 16: Moderate impairment :1/5mg/dl<Cr<3mg/dl Live birth :90% Fetal GR &Preterm delivery>50% Renal function deterioration >1/3 PREGNANCY IS NOT ADVISABLESevere impairement : Cr >3mg/dl Incidence of IP hemorrhage /severe HTN

اسلاید 17: SPECEFIC DISEASE DM Chronic GN CTD Reflux nephropathy

اسلاید 18: GUIDELINE ON MANAGING WOMAN WITH PRE-EXISTING RENAL DISEASECounselingCr<1/4mg/dl Normotensive:DBP=90mmhgFollow upDiuretic &NSPro- restriction

اسلاید 19: Obstetrical management of women with underlying renal disease Frequency of prenatal visit (every two weeks until the third trimester and then weekly )Early detection &treatment of asymptomatic bacteriuria Serial monitoring (at least monthly ) of maternal renal functionClose monitoring for the development of the preeclampsiaFetal surveillance with US&FHR monitoring to assess FG &well-beingTreatment of maternal HTN

اسلاید 20: HTN &PREGNANCYPhysiologic changes in BP during normal pregnancyHypertensive level of BP for development of preeclampsia : SBP>140 mmhg DBP>90mmhgRisk of HTN Fetal risk : IUGR / perinatal death / Preterm delivery Maternal risk : preeclampsia / proteinuriaTreatment of HTN Acute HTN: DBP>100 mmhg DBP>90mmhg Chronic HTN with end organ damage : Goal: BP<140/90 Chronic HTN without end organ damage :Goal:SBP:140-150 DBP:90-100mmhg

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