What Happens To The Kidneys During Pregnancy

What Are The Symptoms Of A Fetal Pelvic Kidney Or Horseshoe Kidney

No symptoms are present in the fetus after birth, one-third of all children diagnosed with this condition do not have any symptoms because the rest of the urinary system has developed normally. However, one-third of all children born with a pelvic kidney have other complications either with their cardiovascular system, the central nervous system or their urinary system. Symptoms directly associated with the horseshoe kidney can include urinary tract infection, kidney stones or hydronephrosis.

Can A Woman Who Is On Dialysis Have A Baby

Some changes in your body make it hard to become pregnant. For example, most women on dialysis have anemia and hormone changes. This may keep them from having regular menstrual periods.

Women with kidney failure are usually advised against becoming pregnant. The rate of complications is very high. Risks to both the mother and developing baby are high. If you are thinking of becoming pregnant, talk to your healthcare provider. If you become pregnant, you will need close medical supervision, changes in medicine, and more dialysis to have a healthy baby.

Changes In Tubular Function

During pregnancy there are alterations in tubular handling of wastes and nutrients. Uric acid excretion increases due to the increases in GFR, decreases in proximal tubular reabsorption, or a combination of both. Serum uric acid levels fall in early pregnancy, reaching a nadir of 2 to 3.0 mg/dL by 22 to 24 weeks, followed by gradual rise to normal by term. The increased clearance is thought to be necessary to handle the increased production from placenta and fetus.

In normal pregnancy there is an increase in total urinary protein and albumin excretion, especially notable after 20 weeks. The protein content in urine is mostly Tamm-Horsfall, with a small amount of albumin and other circulating proteins. The rise in proteinuria during pregnancy is often attributed to the rise in GFR, although the timing does not fall within the peak increase in GFR. There is evidence that the amount of albuminuria increases in late pregnancy, albeit with levels that do not exceed the upper limit of normal.40 Circulating soluble antiangiogenic factors, which are found at unusually high levels in preeclampsia and disrupt the slit diaphragm, are also increased late in normal pregnancy and may explain late-term elevations in proteinuria.41 Another potential factor includes selective alterations in glomerular charge or the presence of other protein material, which is seen in the third trimester.42–44

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Changes In Kidney Hemodynamics

Pregnancy is a state of volume expansion and vasodilation, which occurs in association with careful coordination of several hormones . One of the earliest changes observed in pregnancy is a decrease in blood pressure, approximately 10 mmHg by the second trimester, with mean values of 105/60 mmHg. There are probably various causes, including alterations in the renin-angiotensin-aldosterone system and other hormonal fluctuations. Maternal hormones may influence hemodynamic changes in pregnancy. Mean arterial pressure is decreased in the midluteal phase of menstruation compared with the midfollicular phase in association with a decrease in vascular resistance and rise in cardiac output.17 Progesterone can produce an increase in RPF and GFR, but it cannot account for the magnitude of increase seen in pregnancy. Relaxin is a vasodilating hormone produced by the corpus luteum, decidua, and placenta. It is implicated in the kidney physiology of pregnancy in rodents via upregulation of vascular gelatinase activity, which acts through the endothelial endothelin B receptor-nitric oxide pathway.18 Ogueh and colleagues showed a steady rise in relaxin throughout pregnancy with a decrease postpartum. However, clinical correlations between relaxin levels and hemodynamic parameters, at least in late gestation and postpartum, have not been demonstrated.19,20

Enlarged Kidney In Fetus

An enlarged kidney in fetus happens when a kidney fills up with fluid. Doctors can see it on ultrasound sometime by the 12th week in a pregnancy. It is most often seen in 0.5 percent of female fetuses, and 1 percent of male fetuses. Doctors monitor the kidney throughout pregnancy with frequent ultrasounds and then recheck the kidney after the baby is born. In a small number of cases, surgery may be needed. This article will help you understand the causes of this condition, if it is serious, and what can be done about it.

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Can Kidney Stones Early In Pregnancy Cause Miscarriage

While kidney stones do not directly cause miscarriage, untreated kidney stones can lead to other health complications, such as preeclampsia and urinary tract infections, that could increase the risk of miscarriage. While this outcome is uncommon, it should be taken seriously by both patients and clinicians.

What Tests Are Performed

A number of tests can help find duplicated ureters:

• Ultrasound of your kidneys and bladder can show if there is a duplicate system.
• Computed tomography : Multiple scans are assembled into a three-dimensional image of a body structure.
• Magnetic resonance imaging : An injected liquid dye is traced to show how your kidneys and urinary system function.

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Simple Home Remedies To Cure Kidney Infection

While you do need medical attention to take care of the infection, there are certain home remedies that you can try.

The following remedies are to be used only after discussing with your doctor, as each remedy has its own properties and mechanism and places of action.

• Drinking cranberry juice will make the urine more acidic and help flush out and kill the harmful bacteria.
• Yoghurt is not only an excellent source of antioxidants, but it also hosts a whole plethora of good bacteria which will then proceed to kill and inhibit the growth of the bad bacteria causing the infection.
• You must incorporate foods that are rich in Vitamin C into your diet. This includes citrus fruits, potatoes, and strawberries.
• Juice a bunch of parsley and have it every day in the morning to help flush out the bacteria.
• If you are prone to UTIs then you must consume some amount of apple cider vinegar every day as it neutralizes infections as well as restores the pH levels in the body. Please note- Only pasteurized apple cider vinegar is to be taken during pregnancy.
• Another great diuretic is garlic.
• Echinacea reduces the swelling of the urethra and will make urinating less painful.
• Celery seeds are well known for their antibacterial and antifungal properties.

Can I Prevent An Ectopic Pregnancy

An ectopic pregnancy cannot be prevented. But you can try to reduce your risk factors by following good lifestyle habits. These can include not smoking, maintaining a healthy weight and diet, and preventing any sexually transmitted infections . Talk to your healthcare provider about any risk factors you may have before trying to become pregnant.

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Causes Of Fetal Hydronephrosis

The most common causes of fetal hydronephrosis are obstructions that restrict urine from flowing through the kidney and into the bladder.

Types of fetal hydronephrosis obstructions include:

• Ureteropelvic junction obstruction is a blockage at the point where the kidney meets the ureter.
• Ureterovesical junction obstruction is a blockage at the point where the ureter meets the bladder.
• Posterior urethral valves are obstructive membranes that develop in the lower urethra in males prior to birth.
• Ureterocele occurs when swelling in the ureter causes the ureter to balloon at its opening into the bladder, forming a sac-like pouch.

Other causes of fetal hydronephrosis may include:

• Vesicoureteral reflux occurs when urine in the bladder flows back up the ureters and often back into the kidneys.
• Ectopic ureter occurs when the ureter does not connect properly to the bladder, causing the ureter to drain urine somewhere outside the bladder.
• Neurogenic bladder is a condition in which the nerves that carry messages from the bladder to the brain and from the brain to the muscles of the bladder do not work properly.

In Case Of Polycystic Kidney Disease

If PKD leads to hypertension, your doctor may prescribe medication to control the blood pressure. In case, UTI or urinary tract infection occurs, your doctor may prescribe antibiotics to suppress the infection. However, if more severe complications arise, it may cause kidney failure, and your doctor may recommend dialysis or kidney transplant.

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Prenatal Diagnosis Of Hydronephrosis

Doctors usually diagnose hydronephrosis on a routine ultrasound. If your baby is diagnosed with hydronephrosis, you will need to have follow-up ultrasounds to track the condition. About 85 percent of infants who are diagnosed with mild hydronephrosis before birth have an abnormal urinary tract. The other 15 percent of these infants will get better on their own and have no problems after birth.

Of the 85 percent of babies with a defect, only 15 to 25 percent require surgery to correct it. Amniotic fluid volume is the single most important factor that shows the well-being of the unborn baby. Another finding that causes concern is an enlarged bladder.

Complications Associated With Fetal Hydronephrosis

Fetal hydronephrosis is not associated with any health risks for the pregnant mother. In approximately 50% of cases, fetal hydronephrosis resolves by the third trimester. If fetal hydronephrosis gets worse as pregnancy continues, it usually does not cause any serious problems in the baby and an early delivery is not necessary. If your baby has a more severe case of fetal hydronephrosis, in-utero treatment and treatment after birth may be needed, which may include surgery to help resolve the issue and prevent long-term kidney problems.

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About Utis And Kidney Infections While Pregnant

A urinary tract infection is a very common medical complication of pregnancy. Unless treated, a UTI can cause serious problems in pregnancy. Normal urine is sterile. It contains fluids, salts, and waste products, but is free of bacteria, viruses, and fungi. The tissues of the bladder are isolated from urine and toxic substances by a coating that discourages bacteria from attaching and growing on the bladder wall.

The main parts of the urinary tract are:

• Two kidneys. A pair of purplish-brown organs located below the ribs toward the middle of the back.

• Two ureters. Narrow tubes that carry urine from the kidneys to the bladder.

• Bladder. A triangle-shaped, hollow organ located in the lower abdomen.

• Two sphincter muscles. Circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.

• Urethra. The tube that allows urine to pass outside the body.

Estimating Gfr In Pregnancy

The physiologic increase in GFR during pregnancy normally results in a decrease in concentration of serum creatinine, which falls by an average of 0.4 mg/dl to a pregnancy range of 0.4 to 0.8 mg/dl. Hence, a serum creatinine of 1.0 mg/dl, although normal in a nonpregnant individual, reflects renal impairment in a pregnant woman. The Modification of Diet in Renal Disease formula, which estimates GFR using a combination of serum markers and clinical parameters, has become a standard clinical method to estimate renal function in patients with chronic kidney disease . The use of this formula has not been well studied in the pregnant population, and guidelines on application of the MDRD formula specifically exclude interpretation in pregnant women. Creatinine-based formulas developed in nonpregnant populations are likely to be inaccurate when applied to pregnant women. For example, the fall in serum creatinine during pregnancy reflects not only the pregnancy-induced increase in real GFR but also hemodilution resulting from the 30 to 50% plasma volume expansion by parturition. Perhaps more important, the MDRD formula systematically underestimates GFR as GFR rises above 60 ml/min per m2. This inherent inaccuracy is likely to be more pronounced at the high GFR of pregnancy. Weight-based formulas, such as Cockroft-Gault, might overestimate GFR because the increased body weight of pregnancy does not typically reflect increased muscle mass or creatinine production.

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Shoulder Tip Or Neck Pain

Shoulder tip pain can be a distinguishing factor in diagnosing ectopic pregnancy or miscarriage, as opposed to appendicitis. However, all three conditions require immediate medical attention.

Pain the neck and/or shoulder tip is often the distinguishing symptom indicating that the ectopic pregnancy has ruptured or miscarried. It is because of internal bleeding that irritates the diaphragm. This type of pain is quite unlike that caused by bad posture. The pain may begin suddenly and may often be accompanied by a general sense of discomfort, abdominal pain, or vaginal bleeding.

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What Should Be The Outlook After Treatment

Pyelonephritis needs to be monitored after treatment too. Here is the post-treatment care and monitoring you will need:

1. Screening

After you have been treated for pyelonephritis, your doctor will continue to screen you for any possible reoccurrence of the infection during your regular prenatal routine check-ups. This will include checking on the health of the baby as well as urine tests.

2.After Delivery

Even after delivery, you will have to be screened for the occurrence of the infection of the kidney. While the uterus will no longer be applying pressure on the urinary tract and the hormones would have settled down to the normal levels, there is still a possibility that you will continue to have issues with the kidney depending upon the extent of the initial infection and how soon it was treated.

3.For the Baby

If the pyelonephritis is not treated in a timely manner, the infection could affect the amniotic sac leading to preterm delivery. In such a case, the health of the baby will have to be closely monitored in the initial months in order to ensure that all systems including the immune system are fully developed with no lasting ill effects.

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What Kind Of Birth Control Is Recommended For Kidney Patients

Dialysis and transplant patients who are sexually active and have not undergone menopause should use birth control to prevent pregnancy. Your healthcare provider can recommend the type of birth control that should be used. Many women who have high blood pressure should not use “the pill” since this type of medicine can raise blood pressure and increase the chance of blood clots. The diaphragm, sponge, and condom are usually acceptable means of birth control, especially when used with spermicidal creams, foams or jellies. The newer IUD is also possible.

To contact the National Transplantation Pregnancy Registry , call toll-free at 1-877-955-6877 or email . The National Transplantation Pregnancy Registry has been studying pregnancy in transplant recipients since 1991. You can fill out a one-page questionnaire about your post-transplant pregnancy. The information collected has helped countless transplant recipients make family planning decisions.

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What Is Urinary Tract Dilation

Urinary tract dilation occurs when part of the unborn babyâs urinary tract swells abnormally with excessive amounts of urine. The swelling is often caused by a blockage or narrowing of the urinary tract, which stops or slows the urine from leaving the babyâs body. Usually, the swelling goes away on its own, either during the pregnancy or after the baby is born. In more severe cases, which are uncommon, the condition can lead to low levels of amniotic fluid .

The urinary tract consists of two kidneys, two ureters, a bladder, and a urethra. Special arteries in the kidneys make the urine, which then drains into a funnel-shaped area near the opening of each kidney known as the renal pelvis. From there the urine travels via the ureters to the bladder, which collects the liquid before it exits the body through the urethra. When urine leaves an unborn baby, it becomes the main part of the amniotic fluid, the protective liquid that surrounds the baby in the womb. The amniotic fluid plays an essential role in the babyâs development, particularly lung development.

In most cases of urinary tract dilation, the abnormal buildup of urine occurs in the renal pelvis. But the urine can get blocked further down the urinary tract as well, causing the ureters, bladder, or urethra to swell. .

Figure â Urinary tract dilation occurs when a normal urinary tract becomes swollen, or dilated, with fluid .

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How To Treat A Kidney Infection

If you are diagnosed with acute pyelonephritis during pregnancy, then you will be admitted to the hospital where the first round of treatment is IV antibiotics. If you do not respond to this treatment, then you will be given stronger antibiotics in order to kill the infection.

However, if the infection is caused due to an obstruction such as kidney stones, then the treatment will aim to ease the pressure on the kidneys.

Once you are discharged from the hospital, you will have to continue to take oral antibiotics for ten days. There will be around 23% chance of recurrence during and post-pregnancy, so you will be monitored regularly.

Summary Of Audit Measures

• Audit Measure 1: Proportion of UK renal units and obstetric centres with access to a multidisciplinary team to advise and/or manage renal disease in pregnancy.

• Audit Measure 2: Incidence of pregnancies exposed to mycophenolate mofetil and cyclophosphamide within 6weeks prior to date of conception.

• Audit Measure 3: Proportion of women of reproductive age with CKD within the first year of transplantation offered safe and effective contraception.

• Audit Measure 4: Proportion of women of reproductive age with CKD within 6months of a lupus flare offered safe and effective contraception.

• Audit Measure 5: Proportion of women of reproductive age with CKD taking teratogenic medication offered safe and effective contraception.

• Audit Measure 6: Proportion of pregnant women with CKD with quantification of proteinuria before 20weeks gestation.

• Audit Measure 7: Proportion of women with CKD taking prednisolone or calcineurin inhibitors who are screened for gestational diabetes.

• Audit Measure 8: Proportion of pregnant women with CKD offered low dose aspirin before 16weeks gestation.

• Audit Measure 9: Proportion of pregnant women with CKD that have a target blood pressure for pregnancy documented in their antenatal record.

• Audit Measure 10: Proportion of women with CKD given non-steroidal anti-inflammatory drugs in the post-partum period.

• Audit Measure 11: Proportion on women with CKD who are breastfeeding their infants at 6weeks post-partum.

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