Renal Disease & Pregnancy Exam Questions

1. You are counseling Ms. Smith on contraception. Her creatinine levels are 1 mg/dl, her BUN is WNL. Her urine shows no proteinuria, no glycosuria. Her VS this visit are, ht 5’6”, wt 130#, BP 120/80, RR20, HR 72. When advising her about her contraceptive options you state:

a. Kidney disease is a contraindication for Mirena. You should consider other methods. (Transplant pts should consider this, not those with kidney disease.)
b. Yaz is an option for you, and might be a good choice in helping control your acne also. (Yaz is contraindicated in renal disease.)
c. I know you like the combined oral contraceptive you’ve used in the past. By ensuring you have no other risk factors, using the lowest dose estrogen, and monitoring your blood pressure carefully you can still use them.
d. Your chances of getting pregnant are remote—renal insufficiency causes infertility. You do not need contraception. (Pt has mild presentation, fertility not likely affected.)

2. Ms Smith returns to you several years later and wants to discuss getting pregnant. Her creatinine levels are now 1.5 mg/dl, her BUN is still WNL, and she is showing no proteinuria. She has gained 20 pounds and her VS are BP 135/85, RR 20, HR 74. As her provider, it is essential that you notify her of all of the following issues with her planned pregnancy EXCEPT:
a. Once pregnant she will need to be seen every 2 weeks until 28 wks GA, then weekly, with early referral to Obstetrics and Nephrology.
b. Even if her disease remains under control, she will have HEELP and preterm labor. (Rationale—with mild disease she is more likely to have close to normal pregnancy outcomes and complications may be avoided still. She is high risk, even though she is in the mild range. Her indices are going up)
c. You will need to carefully monitor her blood pressure, creatinine levels, blood urea levels, protein levels, cholesterol and urine.
d. Women with renal disease are at an increased risk of preeclampsia, especially in the third trimester.

3. Elevated risk in pregnancy with associated renal disease includes all of the following except:
a. Preterm labor
b. Hypertension
c. Macrosomia (Babies in this scenario would be smaller not larger)
d. Intrauterine growth retardation

4. Mrs. Smith has now had a kidney transplant. She would like to try getting pregnant again. Which of the following statements is not true regarding transplant patients?
a. There is no risk to subsequent pregnancies once her renal function has normalized. (Medications used to maintain transplant may affect the formation of the fetus at the higher doses used immediately post surgery and for 1-2 years after, also risks to the graft and UTIs are reported.)
b. It is recommended that she wait 1-2 years after the transplant before trying to conceive.
c. The medications used to retain her transplant may interfere with certain methods of birth control.
d. Fertility that was adversely affected by her renal failure may rebound as early as 1 month after transplantation.

5. True or False—Renal disease in men only affects their ability to have an erection and does not affect sperm formation or production.