Mamdouh Albaqumi, MD, FASN Nephrology Section Department of Medicine King Faisal Specialist Hospital Hypertension and CKD in the Pregnancy.

Slides:



Advertisements
Similar presentations
AKI in Pediatrics Patrick D. Brophy MD Associate Professor
Advertisements

Hypertensive Crisis during Pregnancy Eric I. Rosenberg, MD, MSPH, FACP.
Hypertension in Pregnancy
The ACOG Task force on hypertension in pregnancy
Hypertensive Disorder in Pregnancy
HYPERTENSIVE DISORDERS OF PREGNANCY Dr. Dianne MP Graham, MD, CCFP Based on Guidelines From SOGC ALARM Course & WHO Guide on Managing Complications in.
Renal Replacement Therapy: What the PCP Needs to Know.
Chronic Kidney Disease in the Elderly Patient: Less May Be More Theodore F. Saad, MD Nephrology Associates, PA Chief, Section of Renal & Hypertensive Diseases.
Farhan Hanif,MD Maternal Fetal Medicine
Prenatal Care in the YK Delta Ellen Hodges, MD Chief of Staff.
Improving Birth Outcomes Rebekah E. Gee, MD MPH MSHPR FACOG.
Effect of pregnancy on the kidney  Increased plasma volume  Increased intravascular volume  Increased GFR  Increased intraglomerular pressure  Hyponatremia.
Care of the pregnant woman Year 2 Lent term. The Case 38 year old booked at 12 weeks gestation in the antenatal clinic Expecting her third baby 1 st baby.
THYROID DISEASE IN PREGNANCY: TREATING TWO PATIENTS Susan J. Mandel, MD MPH Perelman School of Medicine, University of Pennsylvania.
Diabetes and Pregnancy
Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides.
Special Tutorial Programme Professor Deirdre Murphy Trinity College.
AnAemia in Pregnancy Dr. Yasir Katib MBBS, FRCSC Perinatologest.
Renal Failure and Dialysis in Pregnancy David Shure.
Lesley Stevens MD Tufts-New England Medical Center
Feast or Famine: Survival and Chronic Kidney Disease Kerin Worley and Deb Gipson UNC Chapel Hill April, 2004.
Normal physiology of pregnancy First trimester-Increased insulin sensitivity. Late 2 nd and 3 rd trimester insulin resistance possible associated with.
June 22, 2015 Cindy Mitchell OB TEAMS CALL BIRTH CERTIFICATE OPTIMIZATION INITIATIVE.
 To educate pregnant women on the importance of prenatal care and educate them on the complications that pertain to human pregnancy.  To be knowledgeable.
MANAGEMENT HTN IN PREGNANCY. DEFINITIONS The definition of gestational hypertension is somewhat controversial. Some clinicians therefore recommend close.
With one woman dying during pregnancy or complications of childbirth every minute of every day, and 3.6 million neonatal deaths per year, maternal and.
NYU Medical Grand Rounds Clinical Vignette Demetrios Tzimas, PGY 2 October 27, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Case Studies November 19-20, 2009
The State of Ohio Universal Prenatal Booking David S. McKenna, MD, RDMS Maternal-Fetal Medicine Miami Valley Hospital, Dayton OH.
TEMPLATE DESIGN © Maternal and fetal outcomes in women with chronic kidney disease M Kalidindi, S Marlene, K Bennett-Richards,
Diseases and Conditions of Pregnancy pre-eclampsia once called toxemia –a pregnancy disease in which symptoms are –hypertension –protein in the urine –Swelling.
PRE-EXISTING DIABETES AND PREGNANCY 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.
| Africa Regional Meeting on Interventions for Impact in Essential Maternal and Newborn Care, Addis Ababa, Feb 21, 2011 Timing of delivery and induction.
TEMPLATE DESIGN © NEONATAL OUTCOME IN CASES OF PREGNANCY INDUCED HYPERTENSION WITH HYPERURICAEMIA Samra Ayub 1, Ayesha.
SC birth outcomes initiative: building a statewide perinatal quality collaborative.
Epidemiology of preterm birth Stefan Johansson Department of Neonatology, Karolinska university hospital Department of Medical Epidemiology and Biostatistics,
Dialysis: outcome and complications. Introduction Outcomes – 20%+ of dialysis patients die each year, 3YS diabetics ~50% Technical complications –PD –Haemo.
Management of severe hypertension.  For women with persistent chronic hypertension with SBP >160 or DBP >105, start antihypertensive therapy  Maintain.
TIME OF DELIVERY IN HYPERTENSIVE DISORERS OF PREGNANCY Laleh Eslamian MD. Prof. of Obstet & Gynecol Perinatologist, Shariati hospital, TUMS.
POSTTERM PREGNANCY: THE IMPACT ON MATERNAL AND FETAL OUTCOME Dr. Hussein. S. Qublan- Al-Hammad Jordanian Board in Obstet &Gynecology European Board in.
Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 3
Preterm Labor & Preterm Birth Family Medicine Specialist CME Vientiane, Lao PDR December 10 – 12, 2008.
Women’s Health Pregnancy.
Diabetes in pregnancy Timing and Mode of Delivery
Clinical Aspect of Maternal and Child Nursing NUR 363 Lecture 2
R ISK FACORS OF ADVANCED MATERIAL AGE R ISK FACORS OF ADVANCED MATERIAL AGE.
Hyperthyroidism During Pregnancy Overt hyperthyroidism Subclinical hyperthyroidism.
Risk assessment & Screening Nutrition during pregnancy Other preventive measures Health education during antenatal care.
Obstetrical Emergency: Placental Abruption Kelsie Kelly, MD, MPH University of Kansas Department of Family Medicine Partially supported.
Diabetes and the Kidney Richard Kingston Department of Renal Medicine Kent and Canterbury Hospital.
Precepting the Prenatal Patient: A Curriculum for Non OB Family Medicine Physicians.
Immunosuppressive drugs & treatment of HTN in pregnancy Nephrology dept. R2 우용식.
In the Name of God. All women should be assessed at booking for risk factors for a SGA fetus/neonate to identify those who require increased surveillance.
Hypertensive Disorders of Pregnancy - Dr Thomas Carins
Clinical features Abnormal vasculogenesis and angiogenesis and releasing of anti-angiogenic factors results in Vasospasm Endothelial dysfunction Etiology.
Gestational Hypertension
Hypertension Disorders in Pregnancy
Successful pregnancy in a peritoneal dialysis patient – A case report
Mansoura International Hospital Mansoura International Hospital
DIP, GDM; CLINICAL IMPORTANCE AND NEW WHO DIAGNOSTIC CRITERIA FOR GDM
Hypothyroidism during pregnancy
Vital statistics in obstetrics.
MATERNITY WARD NPH.
Tabassum Firoz MD MSc FRCPC University of British Columbia
Pregnancy in Primary Sclerosing Cholangitis
Pregnancy in Chronic Kidney Disease in a Low-Middle Income Country.
Nat. Rev. Nephrol. doi: /nrneph
Pregnancy outcomes in kidney transplant recipients
Pregnancy at Risk: Gestational Conditions
Patient H: changes in circulating sFlt-1 levels and corresponding parameters after two apheresis treatments. Patient H: changes in circulating sFlt-1 levels.
Presentation transcript:

Mamdouh Albaqumi, MD, FASN Nephrology Section Department of Medicine King Faisal Specialist Hospital Hypertension and CKD in the Pregnancy

How many pregnant patients with CKD did you treat? A More than 4 B 2 to 4 C 1 to 2 D None

How many pregnant patients with CKD did you treat? 1.More than to to 2 4.None

How many pregnant patients on Dialysis did you treat? A More than 4 B 2 to 4 C 1 to 2 D None

How many pregnant patients on Dialysis did you treat? 1.More than to to 2 4.None

Case Presentation  She was diagnosed with vesicouretheral reflux at age 8,  Renal function was normal.  UA: trace protein, 0 RBC  Renal US increased echogenicity.  Nuclear scan: 23% function of R kidney. History: Chief complain: Patient is 29 years old Female who presented to ER at 18 weeks gestation with uncontrolled hypertension and Cr 370 umol/L

Case Presentation  Lost follow up for years  Had 2 pregnancies, 2000, 2006 both resulted in still birth in her second trimester  In 2006: Cr umol/L, UA : +1 Protein, 0 RBC History: Chief complain: Patient is 29 years old Female who presented to ER at 18 weeks gestation with uncontrolled hypertension and Cr 370 umol/L

Labs:  Liver function Test, LDH, Uric acid normal  Platelets 370 Hgb 84  Lupus screen, Complements, Anti phospholipids: normal  UA+1 protein, 0 RBC, 24 hour collection: 980mg protein/24h  Uterine US: 19 weeks Fetus  Renal US: bilateral echogenic kidneys On admission:  BP 180/110  No edema Case Presentation UreaCreat.KHCO3GFR 30 mmol/L370 umol/L4.3 mmol/L16 mmol/L14 ml/min

B With the current lab data, How would you treat the patient next? A Emergent C-Section C Control the blood pressure, correct the anemia, and monitor closely. Dialysis

With the current lab data, How would you treat the patient next? 1.Emergent C-Section 2.Dialysis 3.Control the blood pressure, correct the anemia, and monitor closely.

What are the indication for initiating dialysis in moderate to severe CKD (other than uremia and metabolic abnormalities)? A Uncontrolled hypertension B Urea more than 30 umol/L C No maternal indication, but you must start dialysis to improve fetal outcome. D No strong evidence to start dialysis

What are the indication for initiating dialysis in moderate to severe CKD (other than uremia and metabolic abnormalities)? 1.Uncontrolled hypertension 2.Urea more than 30 umol/L 3.DNo maternal indication, but you must start dialysis to improve fetal outcome. 4.No strong evidence to start dialysis

Registry Of Pregnancy In Dialysis Patients Therapeutic Abortion Still Pregnant Surviving Infants Neonatal Deaths Stillbirths Spontaneous Abortion 1st Trimester Spontaneous Abortion 2nd Trimester Okundaye et al. AJKD, Vol 31, No 5 (May), 1998: pp

Registry Of Pregnancy In Dialysis Patients Therapeutic Abortion Still Pregnant Surviving Infants Neonatal Deaths Stillbirths Spontaneous Abortion 1st Trimester Spontaneous Abortion 2nd Trimester Okundaye et al. AJKD, Vol 31, No 5 (May), 1998: pp Still Pregnant Surviving Infants Spontaneous Abortion 2nd Trimester Spontaneous Abortion 1st Trimester Stillbirths Neonatal Deaths Conceived after starting dialysis n=184 Conceived prior to dialysis n=57

Pregnancy in Moderate to Severe CKD Jones et al. NEJM July Surviving Infants Neonatal Deaths & Stillbirths >40 % preterm delivery, >10%fetal distress CKD Still Pregnant Therapeutic Abortion Surviving Infants Neonatal Deaths Stillbirths Spontaneous Abortion 1st Trimester Spontaneous Abortion 2nd Trimester ESRD

Degree of renal failureProposed Management ESRD on dialysisIntensify treatment GFR less than 10ml/mingets pregnant start dialysis GFR ml/min ??????

C What is the optimal blood pressure target in this patient? A Less than 140/90 B Less than 120/80 MAP target of 70 to ensure placental perfusion D No evidence to support a target BP

What is the optimal blood pressure target in this patient? 1.Less than 140/90 2.Less than 120/80 3.MAP target of 70 to ensure placental perfusion 4.No evidence to support a target BP

The Control of Hypertension In Pregnancy Study CHIPS Magee at al. BJOG Jun;114(6):770 N =132 women Less tight BP control DBP 100 Tight BP control DBP 85 serious maternal complications 3.1%4.6% preterm birth36.4%40.0% birth weight2675 +/- 858g2501 +/- 855 g neonatal intensive care unit (NICU) admission 22.7%34.4% serious perinatal complications 13.6%21.5%

C Can we start CAPD in this patient? A Yes, PD can safely be initiated B PD can be initiated only if HD is unsuccessful No, HD is the only safe dialysis modality

Can we start CAPD in this patient? 1.Yes, PD can safely be initiated 2.PD can be initiated only if HD is unsuccessful 3.No, HD is the only safe dialysis modality

Registry Of Pregnancy In Dialysis Patients Therapeutic Abortion Surviving Infants Neonatal Deaths Stillbirths Spontaneous Abortion 1st Trimester Spontaneous Abortion 2nd Trimester Okundaye et al. AJKD, Vol 31, No 5 (May), 1998: pp Still Pregnant Surviving Infants Spontaneous Abortion 1st Trimester Stillbirths Neonatal Deaths Spontaneous Abortion 1st Trimester Therapeutic Abortion Peritoneal Dialysis n=35 Hemodialysis n=149

 BP was controlled with methyldopa, labetolol, hydralazine /90-80  Urea: 30 to 21mmol/L within 1 week  Creatinine: 370 to 312 umol/L  At week 24: controlled BP, Urea 16mmol/L Cr 310umol/L Follow UP

Thank You