Condition Pregnancy/Outcome

1. Asymptomatic Bacteriuria asymptomatic bacteriuria is not treated,

approximately 25% of infected women will
Presentation: develop symptomatic infection
covert bacteriuria has been associated with
preterm or low-birthweight infants
urinary tract infection to be associated with
Treatment: increased risks for low-birthweight infants,
preterm delivery, pregnancy associated
hypertension, and anemia.
2. Cystitis and Urethritis Almost 40 % of pregnant women with acute
Presentation: pyelonephritis have preceding symptoms of
lower tract infection

Treatment:
3. Acute Pyelonephritis leading cause of septic shock during
pregnancy
Presentation: increased incidence of cerebral palsy in
preterm infants.
There appear to be no serious long-term
maternal sequelae
Treatment: Plasma creatinine is monitored because early
studies reported that 20% of pregnant women
developed renal dysfunction.
respiratory insufficiency from endotoxin-
induced alveolar injury
Uterine activity from endotoxin is common
and is related to fever severity
Endotoxin-induced hemolysis is common, and
approximately a third of patients with
pyelonephritis develop anemia
4. Reflux Nephropathy women with reflux nephropathy were treated
during childhood for renal infections. Of these,
Presentation: many also had surgical correction of reflux as
children, and these commonly have
bacteriuria when pregnant
impaired renal function and bilateral renal
Treatment: scarring were associated with increased
maternal complications
5. Kidney Stones women with nephrolithiasis reported
excessive preterm delivery
Presentation:

Treatment:
6. PREGNANCY AFTER RENAL TRANSPLANTATION
fetuses exposed to mycophenolate had birth
defects
Resumption of renal function after
transplantation promptly restores fertility in
reproductive-aged women
75 % of pregnancies resulted in a live birth
Incidence of preeclampsia is high in all
transplant recipients
Viral infectionsespecially polyomavirus
hominis 1, also called BK virus, are frequent
Gestational diabetes is found in
approximately 5 %
Concern persists regarding the possible late
effects in offspring: malignancy, germ cell
dysfunction, and malformations
Cyclosporine is secreted in breast milk,
 pregnancy-induced renal hyperfiltration
theoretically may impair long-term graft
survival
occasionally the transplanted kidney
obstructs labor. (60% had CS)
7. POLYCYSTIC KIDNEY DISEASE Hypertension develops in 75%, and
Presentation: progression to renal failure is a major problem
Superimposed acute renal failure may also
develop from infection or obstruction from
ureteral angulation by cyst displacement.
Treatment: Asymptomatic hepatic cysts coexist in a third
of patients.
Approximately 10 % of patients with
polycystic kidney disease die from rupture of
an associated intracranial berry aneurysm.
Up to a fourth of patients have cardiac
valvular lesions, with mitral valve prolapse
and mitral, aortic, and tricuspid valvular
incompetence
hypertension, including preeclampsia, was
more common in women with polycystic
kidneys.
Pregnancy does not seem to accelerate the
natural disease course
8. Nephritic Syndromes Varying degrees of renal insufficiency and salt
Presentation: and water retention result in edema,
hypertension, and circulatory congestion
Acute nephritic syndromes during pregnancy
can be difficult to differentiate from severe
Treatment: preeclampsia or eclampsia

9. Nephrotic Syndromes hypertension, and along with albumin
Presentation: nephrotoxicity, renal insufficiency eventually
develops.
Incidence of thromboembolism is increased
and varies with the severity of hypertension,
Treatment: proteinuria, and renal insufficiency
both arterial and venous thromboses may
develop
Management of edema during pregnancy can
be particularly challenging as it is intensified
by normally increasing hydrostatic pressure in
the lower extremities.
massive vulvar edema may develop caused
by
secondary syphilis preeclampsia is common
and often develops early in pregnancy.
fetal-growth restriction
10. Pregnancy and Chronic Renal Disease For all women with chronic renal disease, the
Presentation: incidences of hypertension and preeclampsia,
preterm and growth-restricted infants, and
other problems are high
Loss of renal tissue is associated with
Treatment: compensatory intrarenal vasodilation and
hypertrophy of the surviving nephrons. The
resultant hyperperfusion and hyperfiltration
eventually damage surviving nephrons to
cause nephrosclerosis and worsening renal
function.
With mild renal insufficiency, pregnancy
causes greater augmentation of renal plasma
flow and glomerular filtration
Importantly, chronic renal insufficiency also

11. Dialysis During Pregnancy
12. Obstructive Renal Failure
Presentation:
Treatment:
curtails normal pregnancy-induced
hypervolemia.
Blood volume expansion during pregnancy is
related to disease severity and correlates
inversely with serum creatinine concentration.
pregnancy may accelerate chronic renal
disease progression by increasing
hyperfiltration and glomerular pressure to
worsen nephrosclerosis
mean fetal birthweight was higher in women
who conceived while undergoing dialysis
Maternal complications are common and
include severe hypertension, placental
abruption, heart failure, and sepsis
bilateral ureteral compression by a very large
pregnant uterus is greatly exaggerated.
Resultant ureteral obstruction in turn, may
cause severe oliguria and azotemia
Partial ureteral obstruction may be
accompanied by fluid retention and significant
hypertension. When the obstructive uropathy
is relieved, diuresis ensues and hypertension
dissipates.