Renal physiology in pregnancy (original) (raw)
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1 Renal haemodynamics and tubular function in human pregnancy
Baillière's Clinical Obstetrics and Gynaecology, 1987
Understanding of abnormality must be based upon a realistic appreciation of normality. Without this, the significance of changes observed in disease may be overlooked. This is especially true of the interpretation of early studies of renal function during human pregnancy. Inappropriate control data were obtained from women haphazardly selected during the last few weeks of pregnancy or the first few days of the puerperium or even from men; results were indiscriminately 'corrected' to a standard body surface area and the numbers investigated during any single study were small. As a result, it was incorrectly assumed that renal function changed little during pregnancy and the significance of the changes detected by some workers in women with renal complications was considerably underestimated. This chapter surveys current information about the substantial alterations that are now known to occur in renal haemodynamics and in renal tubular function during normal human pregnancy. Accurate information is difficult to acquire because of the limitations imposed upon research workers by the use of experimental subjects who are not only human but pregnant. Many of the techniques used have been indirect and experimental design has thus on occasions lacked the rigour that can be achieved using animal subjects. However there are important inter-species differences in the renal adaptation to pregnancy. Furthermore, there is no single acceptable animal model for many of the important renal complications of pregnancy, including preeclampsia. Such evidence as we have, despite its lack of precision, is therefore of considerable clinical importance.
Serial Changes in Renal Haemodynamics During Normal Human Pregnancy
BJOG: An International Journal of Obstetrics and Gynaecology, 1981
Effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) were determined at constant intervals during and after the normal pregnancies in 25 healthy women. Compared with non-pregnant values, ERPF increased by 80 per cent during early pregnancy but fell significantly from this new level during the third trimester. GFR, however, remained at a level 50 per cent above the nonpregnant throughout pregnancy. Filtration fraction (GFR/ERPF) was significantly reduced during early pregnancy but rose to a value equivalent to the non-pregnant during the third trimester. Comparable data of previous workers are re-interpreted.
Biochemical Assessment of Pregnancy-Related Physiological Changes in Renal Function
American Scientific Research Journal for Engineering, Technology, and Sciences, 2015
This study was aimed at determining biochemical markers of renal function in pregnant women in Kano State, Nigeria. Urea, electrolytes and creatinine were estimated from 45 pregnant women and 45 non pregnant apparently healthy, age-matched controls. The result of the study showed significant difference (P 0.01) was observed in sodium, potassium and chloride levels between the two groups. Studies within the trimesters showed significant difference (p 0.05) observed in sodium, potassium and chloride level between the control groups and the trimesters of pregnancy. The result obtained is indicative of normal renal function in the study groups.
Journal of the American Society of …, 2009
Nephrologists are frequently called on to diagnose and treat renal disorders in pregnant women. In this review, we update recent literature pertinent to pregnancy and renal disease. We initially begin by describing the application of common clinical estimators of GFR and proteinuria in pregnancy and then summarize recent studies regarding pregnancy in women with chronic kidney disease and the latest information on the use of common renal medications in pregnancy. In the final section, we describe advances in our understanding of the pathophysiology of preeclampsia and the potential clinical implications of these discoveries for screening, prevention, and treatment of preeclampsia.
Journal of Laboratory and Precision Medicine, 2020
Renal disorders in pregnancy are common. In high income countries, approximately 3% of pregnant women have chronic kidney disease (CKD) and often it is recognized for the first time during pregnancy. Approximately one fifth pregnant women developing preeclampsia before 30 weeks' gestation have previously undiagnosed CKD, especially those with severe proteinuria. Defining and staging CKD in pregnancy is challenging: from one hand physiological hyperfiltration might significantly alter CKD staging. On the other hand, the application of equations for estimating glomerular filtration rate (GFR) is strongly discouraged during pregnancy. By analyzing data from the literature, it is reasonable to assume that serum creatinine and albuminuria should be considered the most appropriate tests both for diagnosing and monitoring pregnant women with CKD. Creatinine clearance is cumbersome and the collection of the 24-h urine sample is often inaccurate, while proteinuria is affected by several analytical pitfalls. Serum creatinine should be measured by traceable methods in order to make comparable results between different laboratories. Albuminuria can be screened by dipstick methods; however, any positive result must be confirmed by a quantitative measurement either on a 24-h urine sample or on a first morning urine sample, reporting results as albuminuria-to-creatininuria ratio. Nephelometric methods for albuminuria enable an accurate measurement even in a range of 5-15 mg/L. Any negative dipstick result must be carefully evaluated on the basis of history and clinical signs, tacking into account possible false negative results due to the presence of a protein mixture constituted either by a very low concentration of albumin or by globular proteins only. Cystatin C should be used in the first trimester to predict the risk of preeclampsia and that of gestational diabetes mellitus. Finally, pregnant women with proteinuria must be periodically checked for urinary tract infection (UTI) by urine cultures.
BJOG: An International Journal of Obstetrics and Gynaecology, 1976
Renal plasma flow and glomerular filtration rate were investigated in three positions (supine, left lateral and sitting) in a group of eighteen healthy women during late pregnancy and again after the puerperium. No difference in renal function could be attributed to the position adopted. However, an unexplained decrease in both of the indices occurred during the course of prolonged infusion in any position.
Diseases of Renal Parenchyma, 2012
Page 1. 6 Renal Disease and Pregnancy Marius Craina, Elena Bernad, Răzvan Niţu, Paul Stanciu, Cosmin Cîtu, Zoran Popa, Corina Şerban and Rodica Mihăescu University of Medicine and Pharmacy “Victor Babeş” Timişoara Romania 1. Introduction ...
Renal Disorders in Pregnancy: Core Curriculum 2019
American Journal of Kidney Diseases, 2018
As the incidence of chronic kidney disease increases and women pursue pregnancy at more advanced ages, the management of kidney disease in pregnancy has become increasingly relevant to the practicing nephrologist. Women with kidney disorders face several challenges in pregnancy due to increased physiologic demands on the kidney and risk for disease progression, the potential teratogenicity of medications, and the increased risk for complications such as preeclampsia and preterm delivery. Challenges posed by an underlying disease process in pregnancy, such as autoimmune disease or diabetes mellitus, necessitate an interdisciplinary team to ensure good maternal and fetal outcomes. Rates of acute kidney injury in pregnancy are generally declining worldwide, but remain a significant public health concern in developing countries. Pregnancy may also be the first time that a woman has kidney disease or hypertension diagnosed. An understanding of what constitutes normal physiologic changes in pregnancy is critical in a diagnostic evaluation. In this review, we review physiologic changes in pregnancy, causes and management of acute kidney injury in pregnancy, hypertensive disorders of pregnancy, and how to care for women with chronic kidney disease of various causes, including the use of antihypertensives and immunosuppressants. Complete author and article information provided at end of article.