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Pregnancy lasts 40 weeks, beginning from the first day of your last menstrual cycle and is broken into groups to form three trimesters. Many women find the second trimester easier than the first, experiencing less nausea and fatigue. Try to include fruits, vegetables, and whole grains (complex carbohydrates are better than processed foods). To absorb more iron, include in your meals, some meat, poultry, fish, or vitamin C rich foods, (such as OJ broccoli, or strawberries). If you drink coffee or other caffeinated beverages such as cola, do so in moderation (1 to 2 servings or less per day).
While you are pregnant, the only sure way to avoid the possible harmful effects of alcohol on the fetus is to avoid drinking alcoholic beverages entirely. Vegetarians who eat no dairy products (Vegans) should eat fortified foods such as cereals, breads and rice, as well as fruit juices and soy milk, which have been enriched with additional calcium, Vitamins D, B12. Many vegetarians are also anemic because most iron absorbed by the body comes from animal products. Legumes (peas and beans), nuts, soy, tofu and seeds: Your protein will come from these foods instead of animal products, so aim for five or more servings daily. Fruits and vegetables: These form the basis of most vegetarian diets, so be sure to select 8 or more fruits and vegetables that are full of necessary nutrients. We realize that almost half of all pregnancies among American women are unplanned and unintended. Among the various physiologic alterations that occur in normal pregnancy, few are as striking as those affecting the urinary tract. The kidney is a very complicated organ that adjusts its function depending on the body's situation. During pregnancy the kidneys also adapt to their new state and actually increase the functioning by cleaning the blood more than usual.
Protein in the urine is also a very important part of the evaluation process of a patient's kidney function and especially so in pregnancy, as we will discuss later. HTN occurring as part of pregnancy is relatively common occurring in 12 to 22% of all pregnancies. Chronic HTN by definition either pre-dated pregnancy or had its onset prior to 20th week of pregnancy.
As mentioned previously the main function of the kidney is to clean the blood of the impurities that naturally build up everyday in the body. If the blood levels are above the normal range this often suggests that the patient has impaired renal function. A better way of measuring the kidney function is to collect a 24 hour urine sample and measure both the urine and blood for these levels and from that calculate the kidney function (Creatinine clearance: Cr Cl). In pregnancy the blood levels for BUN and Cr tend to be lower because the kidney function is often super-normal in the pregnancy state. Acute renal failure is defined as the relatively rapid progressive loss of kidney function occurring over a relatively short period of time (days to weeks).
Acute illness wherein the patient has become seriously ill and usually multiple organ systems have become acutely injured. Acute obstruction of the ureters or urethra thus not allowing urine to flow out of the body.
During pregnancy or postpartum one can see on rare occasions ARF from any of the above situations. CRF is by definition distinguished from ARF by the fact that the patient has had loss of kidney function over a more prolonged period of time (more then 3 months and often a process that has been going on for years. Treatment to delay the progression of the loss of kidney function or possibly arrest the progression. Antenatal Strategy and Decision-Making: For a successful outcome, scrupulous attention must be paid to blood pressure control, fluid balance, increased hours of dialysis, and provision of good nutrition. Scrutinize carefully for preterm labor, as dialysis and uterine contractions are associated. Nutrition: despite more frequent dialysis, relatively free dietary intake should be discouraged. Fetal Surveillance and Timing of delivery: cesarean section should be necessary only for purely obstetric reasons. Does CRF place the fetus at risk?There are multiple studies that have documented their results in women with CRF who become pregnant. This is by no means an accurate risk assessment for risk of fetal loss for pregnant women with CRF because it does not take into account the severity of CRF at time of conception.
There is a marked increase in the risk of superimposed preeclampsia in women with CRF who become pregnant.
In women with CRF who become pregnant, there is a high risk of irreversible worsening of renal disease as a consequence of the pregnancy. It has been noted that a longer interval between transplant and pregnancy is associated with decreased risk of low birth weigh and prematurity. A woman should be counseled on the various treatments for renal failure and the potential for optimal rehabilitation. Individual centers have their own specific guidelines, in most; a wait of 18 months to 2 years post-transplant is advised. It appears that pregnancy itself does not adversely affect the transplanted kidney as long as the kidney is functioning well at time of conception.
Summary:In general, prognosis is good if renal dysfunction is minimal and hypertension is absent. The head is extremely large compared to the body, 10 tooth buds are visible and ankles and wrists are formed.
Jamie Straub provides high quality care for women of all ages and is accepting new patients. This will help you and your baby have the best chance of getting all the nutrients you need. That is one reason why we believe women should be well-informed in order to make the best decision for their future. Changes in the urinary tract during normal pregnancy are so marked that norms in the nonpregnant cannot be used for obstetric management. There is no doubt that improvements in our knowledge of background physiology, in prenatal care generally, in technology for fetal surveillance, and in neonatal intensive care have meant better care for women with renal problems and their newborns. The blood is pumped from the heart (about 20% of all the blood is pumped out of the heart goes to the kidneys) and goes to the kidneys via the arteries known as renal arteries.
The bladder is like a muscle sac that stretches to accommodate the urine and then when we urinate, the bladder contracts and the urine is expelled out via another small tube called the urethra that connects the bladder to the outside world.


This is detected by examining blood levels of markers we use to roughly evaluate how "clean" the blood is.
We can get a rough idea on how well the kidneys are functioning by measuring blood levels of certain molecules that build-up when the kidneys are not functioning at 100% capacity.
Renal Failure) are typically identified by the increased blood levels of Cr and BUN on routine blood lab testing. One can detect this by lab testing which shows a steady increase in the creatinine (Cr) on repeat testing over the short time period.
These cases are often very serious and require immediate hospitalization and appropriate medical care by a team of doctors including the nephrologists. This usually requires aggressive *blood pressure (BP) control and sugar control in diabetic patients.
These classes of BP meds provide added kidney protection more so than other BP medications. In late pregnancy the gravid uterus and the supine posture may aggravate this by decreasing venous return. A daily oral intake of 70 gm protein, 1,500 mg calcium, 50 mM potassium and 80 mM sodium is advised, with supplements of dialyzable vitamins. This anemia is usually aggravated further in pregnancy; therefore, blood transfusion may be needed, especially before delivery. They report their results in pregnant women with varying degrees of CRF and only included those pregnant women who made it past the first trimester. In general it is often recommended, to wait for two years after transplant before considering pregnancy. This has turned out to be good advice because, by then, the patient will have recovered from the major surgery and immunosuppression will be at maintenance levels. The diagnosis can be difficult because irregular bleeding and amenorrhea accompany deteriorating renal function or even an intrauterine pregnancy. During the next 12 weeks you may need to make adjustments, such as going to bed earlier and eating smaller but more frequent meals.
Fingers and toes are still webbed and muscles in the neck and trunk begin to contract, causing movement. It is common to have back, abdomen and groin aches as your body adjusts to your baby’s growth. The baby is getting bigger and puts more pressure on internal organs, such as your bladder and stomach. Awareness of all alterations is essential if kidney problems in pregnancy are to be suspected or detected and then handled correctly. The blood tests for creatinine (Cr) and blood urea nitrogen (BUN) are our best blood markers for evaluating kidney function. Idiopathic postpartum renal failure is also called postpartum malignant nephrosclerosis, irreversible renal postpartum renal failure, and postpartum hemolytic uremic syndrome (HUS).
Dietary changes including a moderate restricted protein diet and avoiding potentially kidney damaging medications such as commonly used anti-inflammatory medications.
Unfortunately these medications are CONTRAINDICATED during pregnancy because of their high risk of causing fetal malformations. Caution is necessary because transfusion may exacerbate hypertension and impair the ability to control circulatory overload, even with extra dialysis. It could be argued; however, that elective cesarean section in all cases would minimize potential problems during labor. The standard immunosuppressive drugs (Cyclosporin and azathioprine) are not associated with increases in fetal abnormalities. Even after transplantation, stress will still be a major factor in everyday life, which will always have a "baseline of uncertainty". Also, if function is well maintained at 24 months, there is a high probability of allograft survival at 5 years. Patients may be at higher risk of ectopic pregnancy because of pelvic adhesions due to previous urologic surgery, peritoneal dialysis, pelvic inflammatory disease, or overzealous use of intrauterine contraceptive devices. CRF) then the risk of accelerating the loss of renal function with pregnancy is similar to that seen in patients with CRF. If you are not a big on dairy, then you should take two calcium supplements 500-600mg each, like Os-cal or Viactiv chews, Citracal or Caltrate. Most women with mild to moderate renal disease tolerate pregnancy well and have a successful obstetric outcome without adverse effect on the natural history of the underlying renal lesion.
On the other hand if one does not drink much fluid, then the urine becomes very concentrated. To get a more precise evaluation of the kidney's cleaning of the blood we can measure in the 24 hour urine collection for creatinine and protein.
The purpose of these filtering packets is to filter out the bad stuff and leave the good stuff like protein (building blocks of our muscles) in the blood.
It is rare and frequently fatal syndrome, characterized by the onset of renal failure 3 to 10 weeks into the puerperium after the patient has had an uneventful pregnancy and delivery.
Patients who are taking these medications and become pregnant must come off these medications immediately and alert their physicians right away. In addition, the placenta produces hydroxyvitamin D, one reason why oral supplementation may have to be curtailed. Fluctuations in blood volume can be minimized if packed red cells are transfused during dialysis.
Couples who want a child should be encouraged to discuss all the implications, including the harsh realities of maternal prospects of survival. The main clinical problem is that symptoms secondary to genuine pelvic pathology are erroneously attributed to the transplant. Crucial determinants are renal functional status at conception, the presence or absence of hypertension, and the type of renal disease. Because we have so many of these filtering packets and our lab tests are so sensitive we can actually measure the normal micro amounts of protein that a normal patient spills. The patient develops marked azotemia and severe hypertension and frequently associated with hemolytic anemia and disseminated intravascular coagulation (DIC). Most studies have shown that the harm from these medications occurs if the medication is continued after the first trimester (after the 13th week). There have been cases of women on dialysis during pregnancy going on to delivery but there is a high risk of prematurity and low birth weight in the newborn in these cases. All this poses risks for fetal nutrition, plus the fact that the exact impact on the uremic environment is difficult to access. In the absence of severe maternal problems, the hazards of pregnancy in renal transplant patients are minimal, and successful obstetric outcome is the rule.


Near term, a 15 to 20% decrement in glomerular filtration rate (GFR) occurs, which affects serum creatinine minimally. A normal person can spill up to 20 mg of albumin (special protein we test the urine for) in a 24 hour urine collection. The use of parenteral nutrition supplementation in pregnancy in these gravidas has been advocated. Some kidney diseases damage these filtering packets which then become like a sieve and cause leakage of excess albumin in the urine.
Unnecessary blood sampling should be avoided in the face of anemia and lack of venipunture sites. Depending on the disease and the severity of protein spillage can be mild, moderate or severe. The protocol for various tests usually performed in a particular unit should be followed strictly, with no more blood removed per venipunture than is absolutely necessary.
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