Can be divided into

152 Basic Nephrology and Acute Kidney Injury

A dilatation of ureters and pelvis occurs till pelvic brim (iliac sign) with dilatation more pronounced on right secondary to dextrorotation of uterus and dilatation of right ovarian venous plexus. This leads to urinary stasis and an risk of urinary tract infections (UTIs). There is an increase in kidney size by 1-1.5 cm. As a rule, all the physiologic changes maximize by the end of the second trimester and then start to return to the prepartum level, whereas changes in the anatomy take up to 3 months postpartum to subside.(Hou, S . 1998,

There is increase in aldosterone, desoxycorticosterone, progesterone, relaxin, oxytocin and vasodilating prostaglandins and a decrease in vasopressin (due to vasopressinase) and also

**Urine examination**- Microscopic hematuria may be seen in 20% but is not persistent and

MDRD formula- Creatinine-based formulae are inaccurate in pregnancy. The Modification of Diet in Renal Disease (MDRD) formula underestimates GFR by 40ml/min. Among pregnant women with preeclampsia or CKD, MDRD formula is

Creatinine clearance by24-h urine collection closely approximates GFR by inulin clearance among healthy pregnant women and is the gold standard in pregnancy. Weight-based formulas such as Cockroft-Gault formulae overestimate GFR by

Urine protein excretion increases in pregnancy and upto 300 mg /day is normal. Albumin excretion is also increased .These values return to normal by 6th month post partum. Twentyfour-hour urine collection, although the gold standard for proteinuria quantification is cumbersome, inaccurate and result is delayed. The use of the protein to creatinine ratio ( P:C ratio) to estimate24-h protein excretion is controversial in pregnancy though it has become the preferred method for the quantification of proteinuria in non pregnant population, because of high accuracy, reproducibility, and convenience. Most misclassifications occur in women with borderline proteinuria (250 to 400 mg/d). Hence, it is reasonable to use urine P:C ratio for

**Renal biopsy in pregnancy** - Indications include severe symptomatic nephrotic syndrome and rapidly progressive renal failure. Biopsy can be done in 2nd trimester with patient in

Certain renal diseases are common in pregnancy. (Ananth Karumanchi,S 2007, Schrier RW 1997). Incidence of AKI in pregnancy is 1:20,000 and comprises 25% of AKI in developing countries with substantial mortality . Acute renal failure in pregnancy can be induced by any of the disorders leading to renal failure in the general population, such as acute tubular necrosis due to infection, glomerulonephritis related to lupus, or drug toxicity. There are,

disappears after delivery. Proteinuria glycosuria, and hypercalciuia may be seen.

slightly better, underestimating GFR by 23.3 and 27.3 ml/min respectively.

resistance to action of aldosterone and renin.(August, P 1995)

**1.1.2 Anatomic changes** 

Chris Baylis, 1987)

**1.1.3 Hormones** 

lateral position.

**1.1.4 Renal function tests** 

**Glomerular filtration rate (GFR) –** 

approximately 40 ml/min.

**Estimating of proteinuria during pregnancy** 

**2. Acute kidney injury in pregnancy** 

diagnosis , with 24-h collection undertaken when result is equivocal.


In a study carried out at Osmania General hospital ,Hyderabad ,India over a period of 8 years Obstetric renal failure accounted for 12.1% with PIH as the commonest cause accounting for 39.3%, PPH 20.7% ,Puerperal sepsis 10.6%, APH-9.2%.Septic abortion-4.9%,HUS-3.4% and 11.7% were undetermined .
