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Journal ArticleDOI

Renal Physiology of Pregnancy

01 May 2013-Advances in Chronic Kidney Disease (NIH Public Access)-Vol. 20, Iss: 3, pp 209-214
TL;DR: The kidneys increase in length and volume, and physiologic hydronephrosis occurs in up to 80% of women, which is fundamental in caring for the pregnant patient.
About: This article is published in Advances in Chronic Kidney Disease.The article was published on 2013-05-01 and is currently open access. It has received 385 citations till now. The article focuses on the topics: Pregnancy & Renal function.
Citations
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Journal ArticleDOI
TL;DR: This review highlights the important changes that take place during normal pregnancy as well as highlighting the important differences between normal physiological changes and disease pathology.
Abstract: Physiological changes occur in pregnancy to nurture the developing foetus and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important changes that take place during normal pregnancy.

813 citations

Journal ArticleDOI
TL;DR: The normal cardiovascular physiology of pregnancy is reviewed to provide clinicians with a basis for understanding how the presence of cardiovascular disease may compromise the mother and fetus and how their decisions about medical care may need adjustment.
Abstract: Pregnancy is a dynamic process associated with significant physiological changes in the cardiovascular system These changes are mechanisms that the body has adapted to meet the increased metabolic demands of the mother and fetus and to ensure adequate uteroplacental circulation for fetal growth and development Insufficient hemodynamic changes can result in maternal and fetal morbidity, as seen in preeclampsia and intrauterine growth retardation In addition, maternal inability to adapt to these physiological changes can expose underlying, previously silent, cardiac pathology, which is why some call pregnancy nature’s stress test Indeed, cardiovascular disease in pregnancy is the leading cause of maternal mortality in North America1 We therefore review here the normal cardiovascular physiology of pregnancy to provide clinicians with a basis for understanding how the presence of cardiovascular disease may compromise the mother and fetus and how their decisions about medical care may need adjustment Pregnancy is associated with vasodilation of the systemic vasculature and the maternal kidneys The systemic vasodilation of pregnancy occurs as early as at 5 weeks and therefore precedes full placentation and the complete development of the uteroplacental circulation2 In the first trimester, there is a substantial decrease in peripheral vascular resistance, which decreases to a nadir during the middle of the second trimester with a subsequent plateau or slight increase for the remainder of the pregnancy3 (Figure 1) The decrease is ≈35% to 40% of baseline Systemic vascular resistance increases to near-prepregnancy levels postpartum,4 and by 2 weeks after delivery, maternal hemodynamics have largely returned to nonpregnant levels5 Increased vascular distensibility, or compliance, has been observed in normal human pregnancy starting in the first trimester6 Systemic vascular resistance increases to near-prepregnancy levels postpartum4 Vasodilation of the kidneys results in a 50% increase in renal plasma flow and glomerular filtration …

620 citations


Cites background from "Renal Physiology of Pregnancy"

  • ...Progesterone is a potent aldosterone antagonist that acts on the mineralocorticoid receptor to prevent sodium retention(36) and to protect against hypokalemia.(7) The importance of aldosterone is evident in preeclampsia in which plasma volume is reduced and aldosterone concentrations are low....

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  • ...This results in decreases in serum creatinine, urea, and uric acid values.(7)...

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  • ...In the second and third trimesters, there is an increase in exchangeable sodium of ≈500 mEq (≈20 mmol/wk)(34) and a net gain of ≈1000 mg.(7) Furthermore, during pregnancy, relaxin stimulates increased vasopressin secretion and drinking, resulting in increased water retention....

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Journal ArticleDOI
TL;DR: The changes that occur in maternal physiology in response to pregnancy and the significance of placental hormone production in mediating such changes are examined.
Abstract: During pregnancy, the mother must adapt her body systems to support nutrient and oxygen supply for growth of the baby in utero and during the subsequent lactation. These include changes in the cardiovascular, pulmonary, immune and metabolic systems of the mother. Failure to appropriately adjust maternal physiology to the pregnant state may result in pregnancy complications, including gestational diabetes and abnormal birth weight, which can further lead to a range of medically significant complications for the mother and baby. The placenta, which forms the functional interface separating the maternal and fetal circulations, is important for mediating adaptations in maternal physiology. It secretes a plethora of hormones into the maternal circulation which modulate her physiology and transfers the oxygen and nutrients available to the fetus for growth. Among these placental hormones, the prolactin-growth hormone family, steroids and neuropeptides play critical roles in driving maternal physiological adaptations during pregnancy. This review examines the changes that occur in maternal physiology in response to pregnancy and the significance of placental hormone production in mediating such changes.

273 citations

Journal ArticleDOI
TL;DR: This review summarizes the published data, available guidelines, and recommendations for use of cardiovascular medications during pregnancy for pregnant women with cardiac disease.

136 citations

Journal ArticleDOI
TL;DR: This review focuses on the many advances in the understanding of RXFP receptors in the last 5 years, their signal transduction mechanisms, the development of novel compounds that target RXFP1–4, the challenges facing the field, and current prospects for new therapeutics.
Abstract: Relaxin, insulin-like peptide 3 (INSL3), relaxin-3, and INSL5 are the cognate ligands for the relaxin family peptide (RXFP) receptors 1–4, respectively. RXFP1 activates pleiotropic signaling pathways including the signalosome protein complex that facilitates high-sensitivity signaling; coupling to Gαs, Gαi, and Gαo proteins; interaction with glucocorticoid receptors; and the formation of hetero-oligomers with distinctive pharmacological properties. In addition to relaxin-related ligands, RXFP1 is activated by Clq-tumor necrosis factor-related protein 8 and by small-molecular-weight agonists, such as ML290 [2-isopropoxy-N-(2-(3-(trifluoromethylsulfonyl)phenylcarbamoyl)phenyl)benzamide], that act allosterically. RXFP2 activates only the Gαs- and Gαo-coupled pathways. Relaxin-3 is primarily a neuropeptide, and its cognate receptor RXFP3 is a target for the treatment of depression, anxiety, and autism. A variety of peptide agonists, antagonists, biased agonists, and an allosteric modulator target RXFP3. Both RXFP3 and the related RXFP4 couple to Gαi/Gαo proteins. INSL5 has the properties of an incretin; it is secreted from the gut and is orexigenic. The expression of RXFP4 in gut, adipose tissue, and β-islets together with compromised glucose tolerance in INSL5 or RXFP4 knockout mice suggests a metabolic role. This review focuses on the many advances in our understanding of RXFP receptors in the last 5 years, their signal transduction mechanisms, the development of novel compounds that target RXFP1–4, the challenges facing the field, and current prospects for new therapeutics.

104 citations

References
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Journal ArticleDOI
TL;DR: The classification and diagnosis of the Hypertensive Disorders of Pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP), Vol. 20, No. 1, pp. ix-xiv as mentioned in this paper.
Abstract: (2001). The Classification and Diagnosis of the Hypertensive Disorders of Pregnancy: Statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP) Hypertension in Pregnancy: Vol. 20, No. 1, pp. ix-xiv.

1,493 citations

01 Jan 2009
TL;DR: Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.
Abstract: Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.

1,095 citations

Journal ArticleDOI
TL;DR: Peripheral vasodilation occurs early in pregnancy prior to full placentation in association with renal vasodilated and activation of the renin-angiotensin-aldosterone system, suggesting that ANP increases in response to changes in intravasular volume.

453 citations


"Renal Physiology of Pregnancy" refers background in this paper

  • ...Chapman and colleagues documented early rises in GFR and kidney blood flow by inulin and paminohippurate clearances in association with systemic and kidney vasodilation in a series of 10 pregnant women.(25) A series of studies suggests an overall progressive increase in GFR approximating 40% to 50% with peak increases sustained at term in uncomplicated pregnancies....

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Journal ArticleDOI
TL;DR: This paper attempts to describe the changes that occur during human pregnancy in renal hemodynamics and in certain aspects of tubular function, particularly the handling of uric acid and glucose.

308 citations


"Renal Physiology of Pregnancy" refers background in this paper

  • ...A series of studies suggests an overall progressive increase in GFR approximating 40% to 50% with peak increases sustained at term in uncomplicated pregnancies.(26,27) Hyperfiltration has been shown to continue at levels 20% above normal at postpartum week 2(28) and resolve by 1 month postpartum....

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Journal ArticleDOI
TL;DR: Effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) and GFR/ERPF was significantly reduced during early pregnancy but rose to a value equivalent to the non‐pregnant during the third trimester.

261 citations


"Renal Physiology of Pregnancy" refers background in this paper

  • ...Glomerular filtration rate (GFR) increases 50% and renal plasma flow (RPF) increases up to 80% as compared with nonpregnant levels.(1) Tubular function and handling of water and electrolytes are altered, leading to mild increases in proteinuria, glucosuria, lower serum osmolality, and reductions in serum sodium levels....

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