Name: Kannan, Sneha
3E
ACTIVITY ON RENAL AND URINARY TRACT DISORDERS
Section:
Activity 1 On Renal Disorders
1.
An asymptomatic 18 year old patient G2P1 (1001) at 15 weeks AOG presents for her first prenatal
visit and a urine culture is done as part of the prenatal care. The result showed >100,000 gram negative
rods. What is your diagnosis and treatment in this patient?
Ans: Asymptomatic Bacteriuria (ASB)
Treatment: 3 day course of empiric amoxicillin with nitrofurantoin macrocrystal, 100 mg at bedtime
effective.
2.
A 19 year old G1P0 at 20 weeks AOG presents to the emergency room complaining of high grade
fever , chills, nausea, vomiting, dysuria , and flank pain. Her temperature is 39 C, and right costovertebral
angle tenderness is noted. A urinalysis reveals leukocytes, bacteria ,small blood , and large ketones. The
patient’s urine culture will most likely reveal what organism? What is the appropriate management?
Ans: E. coli
Management:
- IV hydration of patient for adequate urinary output
- Vitals and urine output monitoring for worsening sepsis syndrome
- Ampicillin+Gentamicin
3.
A 30 year old G2P1 at 16 weeks AOG came to the emergency room complaining of severe pain that
radiates from her back to the lower abdomen. The patient is afebrile and urinalysis reveals red blood
cells.On ultrasound it showed renal stones. What is the best management plan for this patient and what
advice can you give to the patient?
Ans: Management
- IV hydration and analgesics for pain
- Conservative symptomatic treatment
- Advice to be well hydrated and monitored to see if stone will pass spontaneously
- Advice uteroscopy if it doesn’t pass and specify surgery outcomes and possible complications
4.
What are the tools in the assessment of renal disorders in pregnancy?
Ans:
Urinalysis
Serum creatinine
Ultrasound
IV pyelography
5.
-
-
Cystoscopy
Uteroscopy
MRI
Renal biopsy
What are the renal changes brought about by pregnancy?
Kidneys become larger
Dilatation of structures (calyces, pelvis, ureter) marked and apparent in mid-pregnancy due to
ureteral compression
(+) vesicoureteral reflux.
Increased risk of upper urinary infection
Functional renal hypertrophy
- Glomeruli are larger but the cell numbers do not increase
- Pregnancy – induced intra-renal vasodilatation develops
- afferent and efferent resistance decreases - increased effective renal plasma flow
and glomerular filtration.
- By 12 weeks gestation
- GFR increased by 20 percent above non-pregnant values.
- Plasma flow increases by 40% and glomerular filtration increases by 65%.
- Serum concentrations of creatinine and urea decrease substantially across pregnancy.
Maintaining normal acid-base homeostasis
Osmoregulation
Fluid and electrolyte retention