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Chapter 54: Pregnancy and the Kidney

The upper limit of normal for serum creatinine is lower in pregnancy than in age-matched nonpregnant women because

A. Progesterone interferes with the creatinine assay.

B. Pregnant women have lower rates of muscle breakdown.

C. Increased GFR leads to increased creatinine clearance.

D. Creatinine is cleared by both maternal and fetal kidneys.

The answer is C. During pregnancy, cardiac output, total blood volume, and GFR increase significantly. The rate of creatinine production, which comes from routine muscle catabolism, remains unchanged. Steady creatinine production and increased creatinine clearance results in a lower serum creatinine level. The upper limit of normal creatinine during pregnancy is 0.8 mg/dL. Progesterone does not have an effect on the measurement of serum creatinine. Pregnant women do not have lower rates of muscle breakdown compared to nonpregnant women. Maternal serum creatinine is not cleared in any significant way by fetal kidneys.

Which of the following is TRUE regarding pregnancy in a woman with a renal transplant?

A. Azathioprine and cyclosporine are mainstays of immunosuppression.

B. Women with pelvic grafts should always have cesarean sections.

C. Reactivation of viral infections may affect fetal health.

D. Prednisone is a teratogen.

E. A and C.

F. B and C.

The answer is E. Azathioprine and calcineurin inhibitors, including cyclosporine and tacrolimus, are commonly used and well-tolerated in pregnancy. Immunosuppression puts transplant patients at higher risk of infection, which has important consequences for fetal growth and development. Prednisone is not a teratogen and may be used during pregnancy, particularly at low dosages. Women with transplants may give birth vaginally or by cesarean section. Maternal fetal medicine specialists and transplant nephrologists should follow any pregnant patient who has a kidney transplant.

Atypical HUS in pregnancy is a thrombotic microangiopathy that most often

A. Occurs in women with lupus and antiphospholipid antibody syndrome

B. Occurs after delivery of the fetus

C. Presents with acute liver failure

D. Results in seizures and permanent neurologic sequelae

The answer is B. Hemolytic uremic syndrome is a thrombotic microangiopathy that occurs most commonly in the postpartum period, although it can occur in the late second or third trimester. There is no association ...

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