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ABIM NEP Pregnancy

ABIM Nep Pregnancy & Kidney

QuestionAnswer
—-% of women with chronic hypertension develops preeclampsia. 25%
T/F worsening proteinuria during pregnancy suggest preeclampsia FALSE. It can be from CKD with increased GFR.
Preeclampsia increases risks of ______. HTN, CKD, ESRD, CVA, CAD, cardiomyopathy
T/F blood pressure control reduces the risk of preeclampsia FALSE, but it lowers rate of complications.
BP meds and breast-feeding Labetalol okay to use, avoid atenolol
T/F ACE-I are safe during breast-feeding. TRUE
How do you distinguish preeclampsia from TTP/HUS? preeclampsia develops after 22 weeks, TTP/HUS and intrinsic renal disease can present earlier
Factors associated with adverse renal outcomes during pregnancy? creat > 1.3 and microalbuminuria
Lupus nephritis and pregnancy recommendations? Optimal timing is to wait 6-12 months w/o activity. 20-60% chance of flare.
T/F cyclophosphamide is safe during pregnancy. FALSE, cyclophosphamide is teratogenic.
When is it safe to perform biopsy during pregnancy? before 23 weeks
T/F ACE-I are contraindicated during breast-feeding. False
What is major effect of blood pressure control during pregnancy in those w HTN? lowers complications from severe HTN but does not reduce risk of preeclampsia.
Creatinine > _____ is associated with acceleration of renal function loss during pregnancy. greater than 1.4
T/F diabetes increases risk of overt nephropathy and women with normal renal function at conception. False
Best BP agents during pregnancy? methyldopa, labetalol, nifedipine XR. Diuretics are safe to continue, But usually not started during pregnancy. Hydralazine, diltiazem, verapamil are also acceptable.
What BP meds are contraindicated during pregnancy? ACE-I and RAAS antagonists. Both associated with fetal anomalies
Thrombotic microangiopathy eval? ADAMTS13 < 5% is likely from TTP. Levels >5% suggest a typical HUS (pregnancy, genetics, cancer, drugs)
Usually initiate antihypertensive therapy in adult pregnant women at BP of ____. 150/100. Some wait ≥160/110 mmHg
Usual goal BP for HTN in pregnancy? 140 to 150 / 90 to 100 mm
BP goal in pregnancy WITH complicated or 2cdary HTN(eg, target-organ damage [left ventricular hypertrophy, microalbuminuria, retinopathy], dyslipidemia, maternal age >40 years,CVA, previous perinatal loss, DM)? UTDOL suggests treatment of hypertension, even if mild—> goal: 120 to 140 / 80 to 90 mmHg
T/F Women with a hypertensive disorder of pregnancy are 2x as likely to develop HTN in the 12 months after delivery compared to those normotensive during pregnancy. TRUE
Preeclampsia-related hypertension usually resolves how soon? Usu within few wks (average 16±9.5 days) and is almost always gone by 12 weeks postpartum. But may take as long as 6 mos to resolve
The majority of pregnancy related ____ (name complication) occur in 1st 48 hours postpartum, with ____ (cause) being the strongest risk factor. strokes in PP are usu from hypertension
T/F methyldopa is recommended to take during pregnancy and postpartum. FALSE. safe during pregnancy, but avoid postpartum d/t risk of postnatal depression
Created by: ka1usg