GU-changes-in-pregnancy

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Physiologic Changes in Pregnancy: Renal & Genitourinary Pregnancy ↑ estrogen ↑ angiotensin synthesis in liver Renin-angiotensin- aldosterone system activation ↑ aldosterone ↑ plasma volume ↑ glomerular filtration rate (GFR) Mechanism unclear, possibly 1) ↑ circulating anti- angiogenic factorsà ↑ permeability of glomerular basement membrane, or 2) ↑ plasma volumeà↓ oncotic pressure of plasma at the glomerulus Proteinuria > 300 mg/day, abnormal in pregnancy ↑ hCG level Dilation of renal vasculature ↑ renal vascular & interstitial volume ↑ filtration surface area Overwhelming load of glucose to proximal tubule ↑ urine output ↑ relaxin secreted by placenta Mechanism not well understood ↓ osmotic threshold for ADH release & thirst ↑ ADH secretion & ↑ oral hydration Incomplete reabsorption of glucose Glucosuria Encourage bacterial growth in the urine Urinary tract infection (e.g. cystitis, pyelonephritis) ↑ serum progesterone Uterine rotation as uterus enlarge due to presence of large bowel Ureter compression (R > L) Ureterovesical reflux (back-flow of urine into the ureters/kidneys) Dilatation of ureters (R > L) (hydroureter) & renal pelvis (hydronephrosis) Progesterone competes with aldosterone ↓ sodium reabsorption ↓ plasma sodium concentration Hyponatremia of pregnancy* (pathological if < 130 mEq/L) *Despite factors favoring sodium excretion, there is a net retention of sodium during pregnancy from adaptation of the renal tubules ↑ urinary stasis ↑ excretion of creatinine and urea in urine ↓ serum creatinine and urea ↓ ureteral toneà ↑potential for ureter dilation Mechanism not well understood ↓ peristalsis of ureters ↑ urinary frequency (voiding > 7x/day) ↑ nocturia (voiding ≥ 2x/night) ↓ oncotic pressure of plasma intra-vascularly àwater leaves blood, enters interstitial tissue, and stays there in gravity-dependent regions of the body Pedal +/- ankle edema Author: Simonne Horwitz Reviewers: Claire Lothian, Crystal Liu, Ronald Cusano*, Candace O’Quinn*, Yan Yu* * MD at time of publication Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published June 28, 2020 on www.thecalgaryguide.com