Afectiuni urologice si Afectiuni urologice si sarcinasarcina

Urinary InfectionUrinary InfectionLevelsLevels asymptomatic bacteriuria (>100000 bacteria/ml, no symptoms) 7% pregnancies

cystitis (dysuria, hematuria = bladder infection, no upper tract involvement) 40 % of 1. pyelonephritis (fever, flank pain = kidney infection)

LaboratoryLaboratory urinalysis (WBC, casts, proteinuria, hematuria) urine culture

PrognosisPrognosis prematurity

TreatmentTreatment all cases of asymptomatic bacteriuria urine culture in symptomatic disease hospitalization in pyelonephritis

Asymptomatic bacteriuriaAsymptomatic bacteriuriaSulfasoxizole 1 g po qidCompetes with bilirubin for binding by

glucuronyl transferase and albuminNitrofurantoin50-100 mg po qidHemolytic anemia in G6PDHAmpicillin500 mg po q 6hOral cephalosporin500 mg po q 6h

PyelonephritisPyelonephritis Ampicillin1-2 g iv q 6hParenteral cephalosporin0.5-2 g q 6-8 h

Resistant infectionResistant infection Gentamycin80 mg iv q 8hOto- and nephrotoxicKanamycin0.5 –1 g im q 12 hOto- and nephrotoxicSulfa/trimetoprim Folate antagonist

Acute glomerulonephritis (Acute glomerulonephritis (1 : 40000 pregnancies)1 : 40000 pregnancies)

Diagnosis group A hemolytic streptococcal infection 2 weeks disease free hematuria proteinuria oliguria hypertensionLaboratory elevated ASLO

low serum complements renal biopsy contraindicated

Differential preeclampsiaPrognosis mother as non-pregnant (2 weeks)

increased fetal lossTherapy control blood pressure Diazoxide

HydralazineMetildopa

restrict fluid to output plus insensible loss restrict salt penicillin terminate pregnancy if persistance > 4 weeks

Acute renal failureAcute renal failureCauses in pregnancyHemorrhageplacenta previa

abruptio placentaepostpartum hemorrhageuterine rupture

Severe preeclampsia/eclampsiaSeptic shockseptic abortion

pyelonephritischorioamnionitis

Intravascular hemolysis DIC mismatched transfusion

Formstubular reversible (2 weeks)cortical irreversible

Diagnosis oliguria dilute isoosmotic rich in sodium

Prognosis maternal mortality 20%fetal loss

TreatmentImmediate volume correction (plasma expanders, blood)

diuretic (Furosemide 40 mg iv q 4h) fetal evaluation

Oliguric phasemonitor BUN, creatinine, Na+, K+, fluid input and

output, weight fluid input = output + 500 ml K+ and protein restriction (20 g/day) carbohydrates exchange resins for hyperkalemia dialysis (BUN>120, hyperkalemia, hypervolemia, neurological spt)

Diuretic phase fluid, Na+, K+ replacement normal protein intake when BUN < 80 mg%

Chronic renal diseaseChronic renal diseaseFetal prognosis poor severe hypertension > 160/100 mm Hg severely impaired renal function

creatinine clearance < 60 ml/minBUN > 25 mg%creatinine > 1.5 mg%

good mild/absent hypertensionnormal renal function

Maternal prognosis worsening renal function superimposed preeclampsia severe anemia

Treatment monitor renal function and fetal growth terminate pregnancy if renal function worsens antihypertensives and diuretics restrict dietary salt and protein packed-cell transfusions dialysis