Afectiuni urologice si sarcina

Urinary Infection
Levels

asymptomatic bacteriuria (>100000 bacteria/ml, no symptoms) 7% pregnancies cystitis (dysuria, hematuria = bladder infection, no upper tract involvement) 40 % of 1. pyelonephritis (fever, flank pain = kidney infection) Laboratory urinalysis (WBC, casts, proteinuria, hematuria) urine culture Prognosis prematurity
Treatment all cases of asymptomatic bacteriuria urine culture in symptomatic disease hospitalization in pyelonephritis Asymptomatic bacteriuria Sulfasoxizole 1 g po qidCompetes with bilirubin for binding by glucuronyl transferase and albumin Nitrofurantoin50-100 mg po qidHemolytic anemia in G6PDH Ampicillin500 mg po q 6h Oral cephalosporin500 mg po q 6h Pyelonephritis Ampicillin1-2 g iv q 6h Parenteral cephalosporin0.5-2 g q 6-8 h Gentamycin80 mg iv q 8hOto- and nephrotoxic Kanamycin0.5 1 g im q 12 hOto- and nephrotoxic Sulfa/trimetoprim Folate antagonist

Resistant infection

Acute glomerulonephritis (1 : 40000 pregnancies)

Diagnosis group A hemolytic streptococcal infection 2 weeks disease free hematuria proteinuria oliguria hypertension elevated ASLO low serum complements renal biopsy contraindicated preeclampsia mother as non-pregnant (2 weeks) increased fetal loss control blood pressure Diazoxide Hydralazine Metildopa restrict fluid to output plus insensible loss restrict salt penicillin terminate pregnancy if persistance > 4 weeks

Laboratory Differential Prognosis Therapy

Acute renal failure

Causes in pregnancy Hemorrhage placenta previa abruptio placentae postpartum hemorrhage uterine rupture Severe preeclampsia/eclampsia Septic shock septic abortion pyelonephritis chorioamnionitis Intravascular hemolysis DIC mismatched transfusion Forms tubular reversible (2 weeks) cortical irreversible Diagnosis oliguria dilute isoosmotic rich in sodium

Prognosis
Treatment Immediate

maternal mortality 20% fetal loss

volume correction (plasma expanders, blood) diuretic (Furosemide 40 mg iv q 4h) fetal evaluation

Oliguric phase monitor BUN, creatinine, Na+, K+, fluid input and output, weight fluid input = output + 500 ml K+ and protein restriction (20 g/day) carbohydrates exchange resins for hyperkalemia dialysis (BUN>120, hyperkalemia, hypervolemia, neurological spt) Diuretic phase fluid, Na+, K+ replacement normal protein intake when BUN < 80 mg%

Chronic renal disease

Fetal prognosis poor severe hypertension > 160/100 mm Hg severely impaired renal function creatinine clearance < 60 ml/min BUN > 25 mg% creatinine > 1.5 mg% good mild/absent hypertension normal renal function Maternal prognosis worsening renal function superimposed preeclampsia severe anemia Treatment monitor renal function and fetal growth terminate pregnancy if renal function worsens antihypertensives and diuretics restrict dietary salt and protein packed-cell transfusions dialysis