Urinary tract disorders in pregnancy

Urinary tract disorders in pregnancy
Anatomical changes :-
1.Kidney enlarge during pregnancy .
2.increase circulating hormones (progesterone) & mechanical (pressure of pregnant uterus on bladder ) will lead to dilatation of ureters & pelvi – calcyeal system (97% had hydronephrosis ).This occur from the first trimester , more on right side - staisis – increase UTI (asym.&symptomatic bacteruria ) .
3.Vesico- ureteric reflux occur in 3% will lead to increase incidence of pyelonephritis in pregnancy .

Physiological changes :-
50% increase in R.P.F & G.F.R from the first trimester .
Increase G.F.R will lead to glycosuria 10 times more than non pregnant .2/3 had glycosuria .
Increase GFR will lead to decrease blood urea & uric acid due to increase renal clearance .

Chronic renal disease :-
Risk of pregnancy will depend on :-
1.rate of disease progress .
2. amount of renal damage .
3. hypertenstion is a major risk factor .

Antenatal management :-
1.frequent ANC check B.P to detect H.T or superimposed P.E.T .
2. MSG to detect UTI should be treated .
3. U/S to detect IUGR (common sequale).
Detorioration of renal function , if more than 15-20% need immediate delivery .

Urinary calculi :-
0.3 /1000 pregnant .
Single x-ray for the purpose of diagnosis is not contraindicated at any stage of pregnancy .
Treatment is conservative :- I.V fluid , AB & systemic analgesia .
Usually non- obstructive stone :-AB until after delivery .
Obstructive stone :- need surgery .

Haematuria :-
Commonest cause in pregnancy is UTI .
Other causes :- stone , tumours must be excluded by renal U/S or cystoscopy .

Pregnancy after renal transplantation :-
1.Important the transplanted kidney should be stable , so wait 18 months after transplantation prior to pregnancy.
2. Women should be normotensive prior to pregnancy even by therapy .
3. Immuno-suppresive treatment should be at maintenance dose .
4.Most important that renal function should be adequate to allow increase demand of pregnancy .
5.Risk associated with pregnancy :-
a.H.T, renal failure,& infection(CMV& herpes due to immunpsuppresion).
b.preterm delivery 50% .
c.IUGR 20% .