Slides courtesy of Matt Hall Slides courtesy of

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal Disease and Pregnancy Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Matt Hall Nottingham Renal Unit Slides courtesy of Matt Hall Nottingham University Hospitals Sp. R Club Belfast Hall February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Sex Drugs Rock and roll Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Sex Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and CKD Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 National Statistics Online. Slides courtesy of 2008. http: //www. statistics. gov. uk/downloads/theme_health/conceptions 2008/conceptions 08. pdf Conception statistics Matt Hall Slides courtesy of Matt Hall Brown JH, Maxwell AP, Mc. Geown MG. Irish J Med. 2001 Nottingham University Hospitals. M, Hladunewich M, Keunun J et al. Nottingham University Hospitals Barua Clin J Am Soc Nephrol. 2008; 3: 392/396 February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and CKD Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Approximate. University Hospitals number of pregnancies per year in UK Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Maternal Fetal risks Nottingham University Hospitals February 2011 Maternal and fetal risks Is pregnancy going to Matt Hall Will I take home a healthy baby? Hall Slides courtesy of Matt Nottingham University Hospitals make my kidney disease worse? February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Maternal and fetal risks Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Baseline renal function? Hospitals Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall p=0. 027 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ** ** Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals * February 2011 Slides courtesy of Matt Hall * Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Baseline renal function - yes Hospitals Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Slides courtesy of Matt Hall Baseline blood pressure? Hospitals Nottingham University February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Neonatal death. Matt Hall Slides courtesy of risk Nottingham University Hospitals Diastolic BP 2011 February Absolute risk Slides courtesy of Matt Hall 0. 9% Nottingham University Hospitals Nottingham University<70 Hospitals February 2011 70 -80 3. 2% Blood pressure? Slides courtesy of Matt Hall 80 -90 Nottingham 3. 6% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt >90 or treated 15. 3% Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals p=0. 08 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals p=0. 009 February 2011 Blood pressure? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals women with CKD Nottingham University Hospitals 490 μmol/l) • 43 pregnancies in 30 (serum creatinine 110 to February 2011 • Hypertension was present from conception in 26 (60%). Slides courtesy of Matt Hall • Logistic regression identified uncontrolled hypertension at conception as an Hospitals Nottingham University February 2011 independent Hall February 2011 Slides courtesy of Mattrisk factor fetal death Slides courtesy of Matt Hall • RR fetal death with conception = 10. 5 Nottingham University Hospitals MAP> 105 mm. Hg at. Nottingham University Hospitals February 2011 • Accelerated loss of maternal renal function in 7 patients, all of whom had Blood pressure? hypertension Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 • 168 pregnancies in 118 women with Ig. A nephropathy. Slides courtesy of Matt with Slides courtesy of Matt • Perinatal mortality 33% in women Hall BP>140/90 versus 1% with BP<140/90 Hall Nottingham University Hospitals • (Hypertension not identified as a risk factor for progression of. February 2011 disease. ) maternal February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University. PHospitals Nottingham University Hospitals Jungers et al. Pregnancy in women with impaired renal function. Clin Nephrol 1997; 47(5): 218 -288 February 2011 Abe S. Pregnancy in Ig. A nephropathy. Kidney International 1991; 40: 1098 -1102

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Proteinuria Nottingham University Hospitals ? Baseline renal function - yes Hospitals Nottingham University February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Slides courtesy of Matt Hall Baseline blood pressure - yes Hospitals Nottingham University February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Second trimester. Slides courtesy of Matt Hall OR 1. 9 preterm delivery ACR>3 mg/mmol Nottingham University Hospitals Women 2011 without CKD February 2011 Second trimester ACR>20 mg/mmol OR 4. 7 preterm delivery Slides courtesy of Matt Hall Nottingham University Hospitals Diabetes and February 2011 hypertension Slides courtesy of Matt Hall Nottingham University Hospitals Proteinuria > 3 g/d February 2011 Proteinuria X Women with CKD Creat > 124μmol /l No courtesy on outcome Slides courtesy of Matt Hall Slidesimpact of Matt Hall Nottingham University Hospitals < 3 g/d Nottingham University Hospitals Proteinuria February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Pregnancy (n=19) Proteinuria and Nottingham University Hospitals February 2011 assoc with Women of Matt Hall February 2011 pregnancy Slides courtesywith CKD Slides courtesy of Matt Hall PALRF Nottingham University Hospitals No pregnancy (n=31) February 2011 Slides courtesy of Matt Hall Franceschini N et al. Maternal urine albumin excretion and pregnancy outcome. Am J Kindy Dis. 2005’ 45(6): 1010 -1018 Nottingham University Hospitals Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. New Engl J Med 1991; 336(4): 226 -223 February 2011 Hemmelder MH et al. Proteinuria: a risk. February 2011 factor for pregnancy-related renal function decline in primary glomerular disease? A, m J Kidney Dis 1995; 2691): 187 -192

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Proteinuria? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Imbasciati E et al. AJKD 2007; 49: 753 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals PALRF February 2011 Slides courtesy of Matt Hall Yes No p value Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall n 6 Nottingham University Hospitals 21 February 2011 age (years) Mean (SD) February 201133. 0 (3. 7) Maternal 30. 4 (3, 3) 0. 103 Slides courtesy of Matt Hall Median (range) Gravidity 3 (1 -4) 3 (1 -5) 0. 057 Nottingham University Hospitals n (%) February 2011 0. 357 Underlying glomerular disease Slides courtesy of Matt Hall Slides courtesy 2 (33%)Hall 13 (69%) of Matt Proteinuria? Nottingham University Hospitals February 2011 Mean (SD) Baseline serum creatinine (μmol/l) 111 (46) 81 (20) 0. 027 Slides courtesy of Matt. Mean (SD) Hall Slides courtesy of Matt Hall Baseline e. GFR (ml/min) 63 (28) 79 (16) 0. 077 Nottingham University Hospitals Median (IQR) February 2011 0. 345 Baseline protein: creatinine ratio 29 (206) 46 (272) Slides courtesy of Matt Hall (mg/mmol creatinine) Nottingham University Hospitals Median (IQR) February 2011 decline in e. GFR prior to February 2011 Rate of 0. 44 (4. 15) -0. 50 (3. 52) 0. 932 conception (ml/min/year) courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Mean (SD) Slides courtesy of Matt Hall Slides courtesy of systolic BP (mm. Hg) Baseline Matt Hall 143. 1 136. 6 0. 08 Nottingham University Hospitals (18. 3) (20. 8) February 2011 Mean (SD) Baseline diastolic BP (mm. Hg) 81. 0 (4. 7) 71. 6 (9. 7) 0. 009 Slides courtesy of Matt Hall n (%) Receiving antihypertensives 5 (83. 3%) 7 (33. 3%) University Hospitals 0. 003 Nottingham University Hospitals Nottingham February 2011 Table. Demographic and clinical parameters of study cohort

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals p=0. 60 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals p=0. 03 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 p=0. 86 Proteinuria Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Proteinuria Slides courtesy of Matt Hall maternal? no Slides courtesy of Matt Hall Baseline renal function - yes Hospitals Nottingham University Hospitals fetal? yes February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Slides courtesy of Matt Hall Baseline blood pressure - yes Hospitals Nottingham University Nottingham Aetiology of kidney disease? University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Perinatal Preterm Renal function February 2011 blood Permanent Slides courtesy of Matt Hall loss delivery decline pressure Nottingham University Hospitals increase February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals FSGS (n=85) 23% 32% 13% 10% February 2011 Slides courtesy of Matt Hall Membranous GN (n=110) 4% 35% 3% 3% Nottingham University Hospitals February 2011 Ig. A nephropathy (n=268) 15% 21% 12% Aetiology of kidney disease? ct ffe fe s o e ce om n c de ut vi o e n ng y o ci og in ol v ti on ae c o of N Slides courtesy of Matt Hall MC GN (n=278) 12% 9% 2% 7% Nottingham University Hospitals February 2011 Slides courtesy ofnephropathy (n=97) Matt Hall Slides courtesy of Matt Hall Diabetic 6% 32% 58% Nottingham University Hospitals February 2011 Polycystic disease (n=464) 3% 10% 3% 14% Slides courtesy of Matt Hall Reflux nephropathy (n=137) 7% 15% Nottingham University Hospitals 0. 7% Slides courtesy of Matt Hall 11% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall of pregnancy outcomes by aetiology of CKD. FSGS, focal segmental Slides courtesy of Matt Hall Comparison Nottingham University Hospitals glomerulosclerosis; GN, glomerulonephritis; MC, mesangiocapillary. February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides SLE courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal Aetiology of kidney disease? dysfunction. Slides courtesy of Matt Hall Antiphospholipid Slides courtesy of Matt Hall syndrome Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Hypertension of Matt Hall Slides courtesy Anti-Ro antibodies Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Medication Nottingham University Hospitals All associated with adverse February 2011 Not the “SLE” label itself outcomes Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Reflux nephropathy Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Increased risk Aetiology of kidney disease? of UTI Slides courtesy of Matt. Preterm Hall labour Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Neonatal morbidity Slidesand mortality. Hall courtesy of Matt Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Increased risk Maternal Slides courtesy of Matt Hall of pyelonephritis mortality Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Diabetes Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of kidney disease? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of renal disease? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Proteinuria Slides courtesy of Matt Hall Baseline renal function - yes Hospitals maternal? no Nottingham University Hospitals Nottingham University February 2011 fetal? yes February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Slides courtesy of Matt Hall Baseline blood pressure - yes Hospitals Aetiology of kidney disease – not really. Hospitals Nottingham University February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Hawk-like observation Masterful inactivity Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Preconception February 2011 counselling Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD in pregnancy Limited interventions Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Urinary tract Pre-eclampsia University Hospitals Medicines Blood Thrombo. Nottingham University Hospitals pressure Nottingham infection prophylaxis 2011 prophylaxis management control February 2011 February nt treatment Im m un tw osu ea pp ka re ge ss a Slides courtesy of Matt Hall Nottingham University Hospitals ma Dia l n 2011 Februaryip ysis Slides courtesy of Matt Hall ula tio Nottingham University Hospitals n February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Timing of delivery

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Pre-eclampsia prophylaxis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Aspirin 75 mg od. February 2011 Systematic review Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 37560 women Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 All women courtesy of Matt. High risk women Slides courtesy of Matt Hall Slides Hall Nottingham University Hospitals February 2011 February 17% relative 2011 25% relative Management of CKD and hypertension in pregnancy Pre-eclampsia prophylaxis risk reduction Slides courtesy of Matt Hall Slides courtesy risk reduction of Matt Hall Nottingham University Hospitals February 2011 NNT =Slides courtesy of Matt Hall February 2011 72 NNT = 19 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Perinatal death RRR 14%Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Preterm delivery RRR 8%February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 SGA RRR 10% Slides courtesy of Matt Hall Nottingham University Hospitals Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst. Rev. 2007 Apr February 2011 18; (2)(2): CD 004659.

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Thrombo-prophylaxis • Not evidence based • Different practices between (and within) centres. Slides courtesy of Matt Hall Nottingham University Hospitals Nephrotic syndrome University Hospitals Pregnancy February 2011 Slides courtesy of Matt Hall = 1. 7 Slides courtesy= 4. 3 Hall RR VTE of Matt Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Heavy proteinuria Pregnancy Nottingham University Hospitals RR VTE February 2011 RR VTE = ? February 2011 = 4. 3 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ?

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Add-up Nottingham University Hospitals risk factors Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals LMWH Nottingham. No treatment University Hospitals Prophylactic February 2011 Management of CKD and hypertension in pregnancy Thrombo-prophylaxis Slides courtesy of Matt Hall Nottingham. If renal impairment, University Hospitals Nottingham University Hospitals February 2011 monitor Factor Xacourtesy of Matt Hall February 2011 Slides courtesy of Matt Hall Slides levels Nottingham University Hospitals February 2011 Low threshold for Slides courtesy of Matt Hall Slides courtesy Matt investigating suspectedof. VTEHall Nottingham University Hospitals February 2011 Treat until 6 weeks Slides courtesy of Matt Hall Nottingham University Hospitals postpartum February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Pyelonephritis Asymptomatic bacteruria of Matt Hall Slides courtesy of Matt Hall 4 x. Hospitals increased risk Nottingham University Hospitals in pregnancy February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 21% risk of progression if untreated Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Treatment of asymptomatic bacteruria in Slides courtesy of Matt Hall Nottingham University Hospitals pregnancy reduces the incidence of February 2011 pyelonephritis by 75% Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals …Antibiotic treatment of February 2011 asymptomatic bacteruria is Matt Hall Slides courtesy of indicated to reduce the risk of Hospitals Nottingham University February 2011 pyelonephritis in pregnancy… Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Slides courtesy of Matt Hall Slides courtesy of Matt …Antibiotic treatment of University Hall Nottingham University Hospitals Nottingham Hospitals asymptomatic bacteruria was February 2011 Slides courtesy of Matt Hall associated with a reduction in Nottingham University Hospitals the incidence of low birth weight February 2011 babies (RR 0. 66 (0. 49 -0. 89))… Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Based on studies from 1960 -1970 s Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall n=85, 484 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Non-pyelonephritic February 2011 Pyelonephritis Asymptomatic bacteruria Slides courtesy of Matt Hall UTI Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 February Preterm birth 2011 Preterm birth Management of CKD and hypertension in pregnancy Urinary tract infection Slides courtesy of Matt Hall 7. 7% Slides courtesy of Matt Hall 8. 3% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 7. 2% Small for gestational age Slides courtesy of Matt Hall 16. 5% 16. 1% Nottingham University Hospitals Small for gestational age Slides courtesy of Matt Hall 18. 9% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 After adjusting for confounding covariates, no increased risk. Slides courtesy ofbirth Hall of preterm Matt or Slides courtesy of Matt Hall small infant in women exposed to. Hospitals tract infection. Nottingham University urinary Nottingham University Hospitals February 2011 Chen YK et al. Acto Obstet Gynecol Scand 2010; 89(7): 882 -888

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall In pregnancy Nottingham University Hospitals February 2011 Asymptomatic bacteruria Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Non-pyelonephritic February 2011 Treat Slides courtesy of Matt Hall UTI Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Pyelonephritis Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Second or more episode in pregnancy? Nottingham University Hospitals February 2011 Slides courtesy of Asymptomatic bacteruria Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy. Non-pyelonephritic of Matt Hall Slides courtesy of Matt Hall Treat Prophylaxis UTI Nottingham University Hospitals February 2011 Pyelonephritis Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Blood pressure control Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Target February 2011 BP <150/100 Chronic hypertension Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Do not treat to Slides courtesy of Matt Hall Nottingham University Hospitals DBP<80 mm. Hg February 2011 Management of CKD and hypertension in pregnancy Blood pressure control Slides courtesy of Matt Hall Chronic hypertension Target BP <140/90 + CKD Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Target courtesy of Matt Hall February 2011 Slides Chronic. Matt Hall courtesy of hypertension Slides BP ? Nottingham University Hospitals and treat with what? + proteinuric CKD February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Chronic courtesy of Matt Hall Slides hypertension Slides Target BP <140/90 courtesy of Matt Hall Nottingham University Hospitals + proteinuric CKD Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Blood pressure control Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 National Statistics Online. Slides courtesy of 2008. http: //www. statistics. gov. uk/downloads/theme_health/conceptions 2008/conceptions 08. pdf Conception statistics Matt Hall Slides courtesy of Matt Hall Brown JH, Maxwell AP, Mc. Geown MG. Irish J Med. 2001 Nottingham University Hospitals. M, Hladunewich M, Keunun J et al. Nottingham University Hospitals Barua Clin J Am Soc Nephrol. 2008; 3: 392/396 February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 February unit An average sized renal 2011 in the UK Pregnancy and dialysis Slides courtesy of Mattto treat one pregnant patient courtesy of Matt Hall Slides would expect Hall Nottingham University Hospitals on dialysis every four years February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis How do you diagnosis pregnancy in a woman on dialysis? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Amenorrhoea? Pregnancy test from. February 2011 Boots? Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Intradialytic hypotension? February 2011 Pregnancy and dialysis How do you diagnosis pregnancy in a woman on dialysis? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Early ultrasound Nottingham University Hospitals. Serum βh. CG Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Elevated Serum βh. CG but no fetal heart beat? Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Repeat ultrasound Nottingham University Hospitals Serial βh. CG February 2011 weeks in 1 -2 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Target weight Nottingham University Hospitals Increase by 1. 5 kg over first trimester Hospitals Nottingham University February 2011 February 15 0. 2 -0. 4 kg/week from week 2011 Slides courtesy of Matt Hall Weekly. University Hospitals clinical evaluation Nottingham University Hospitals February 2011 Blood pressure Target blood pressure <140/90 of Matt Hall February 2011 Slides courtesy of Matt Hall Slides courtesy Nottingham University Hospitals Do not treat to DBP<80 mm. Hg February 2011 Pregnancy and dialysis Anaemia ESA requirement weeks Slides courtesy of Matt Hall increases by 85% at 28 Slides courtesy of Matt Hall Nottingham University Hospitals Target Hb 10 -11 g/dl February 2011 Slides courtesy of Matt Hall Nutrition Nottingham University Hospitals Protein intake >1. 8 g/kg/day University Hospitals Nottingham February 2011 Energy intake 30 kcal/kg/day Slides courtesy of Matt Hall Slides courtesy of Water soluble vitamin and folic acid supplementation Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Befriend an obstetrician Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals • Fetal growth monitoring every 1 – 2 weeks February 2011 Pregnancy and dialysis • Liquor volume monitoring every 1 -2 weeks Slides courtesy of Matt Hall Slides courtesy 25 weeks • CTG monitoring every dialysis session fromof Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis PD? Yes! Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall • Conception rates. University Hospitals may be lower Nottingham University Hospitals Nottingham • Infection rates no higher February 2011 • No contraindication to Caesarean Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis HD? Yes! Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 How much? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall p<0. 05 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Hou S. Hemodialysis International 2004; 8: 167 -171 February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Hou S. Hemodialysis International 2004; 8: 167 -171 February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Hou S. Hemodialysis International 2004; 8: 167 -171 February 2011 Barua M et February 2011 Nephrol 2008; 3: 392 -396 al. Clin J Am Soc

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Hou S. Hemodialysis International 2004; 8: 167 -171 February 2011 Barua M et February 2011 Nephrol 2008; 3: 392 -396 al. Clin J Am Soc

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Historic observations Nocturnal HD Slides courtesy of Matt Hall Preterm delivery 90% 50% Nottingham University Hospitals February 2011 Slides IUGR/SGA Hall courtesy of Matt Slides 90% courtesy of Matt Hall 17% Nottingham University Hospitals February 2011 Pre-eclampsia 75% 0% Pregnancy and dialysis Perinatal death Slides courtesy of Matt Hall 50% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall 17% Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Williams D, Davison J. BMJ 2008; 336: 211 -215 February 2011 Barua M et February 2011 Nephrol 2008; 3: 392 -396 al. Clin J Am Soc

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals. As much dialysis as you can facilitate Hospitals Nottingham University and February 2011 certainly >20 hours/week Pregnancy and dialysis How much? Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Maintain pre-dialysis urea < 15 mmol/l Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Fertility returns Nottingham University Hospitals within 1 -2 months February 2011 Slides courtesy of Matt Hall of transplant Nottingham University Hospitals February 2011 Transplant and pregnancy Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Pregnancy outcomes Nottingham University Hospitals following transplant are Nottingham University Hospitals February 2011 February vastly better than if still 2011 dialysis on Slides courtesy of Matt Hall 95% success Nottingham University-Hospitals Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal disease and pregnancy – renal transplant General guidelines Slides courtesy of Matt Hall Nottingham University Hospitals 1. Nottingham University Hospitals Wait 2 years post-transplant (some say 12 -18 months) February 2011 Slides courtesy of Matt Hall Stable renal function Slides courtesy of Matt Hall 2. Nottingham University Hospitals 3. Minimal proteinuria February 2011 4. Slides courtesy of Matt Hall Minimal or well-controlled hypertension Slides courtesy of Matt Hall Nottingham University Hospitals 5. Nottingham University Hospitals No transplant rejection February 2011 Slides courtesy of Matt Hall Minimal levels of appropriate immunosuppression Slides courtesy of Matt Hall 6. Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Pregnancy outcomes are predicted February 2011 by Matt Hall Slides courtesy of baseline kidney function Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Baseline creatinine Complicated Successful outcome Nottingham University Hospitals pregnancy February 2011 Renal disease and pregnancy – renal transplant <125 μmol/l of Matt Hall 30% Slides courtesy Nottingham University Hospitals >125 μmol/l February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 82% 97% Slides courtesy of Matt Hall Nottingham University Hospitals 75% February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Persistent post pregnancy kidney function Slides courtesy of Matt Hall Nottingham develops in 15% of transplant patients Nottingham University Hospitals impairment. University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Children. Matt Hall mothers with a renal Slides courtesy of Matt Hall born to Slides courtesy of Nottingham transplant do well in general University Hospitals Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal disease and pregnancy – renal transplant; children Slides courtesy of Matt Hall are due mainly to Slides courtesy of Matt Hall Complications Nottingham University Hospitals preterm delivery and low birth weight February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Overall, 16% of children have special Nottingham University Hospitals February 2011 educational needs (cf. Slides courtesy general Hall February 2011 11% in USA of Matt population) Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall (caution but not contraindication to Nottingham University Hospitals radiation exposure) February 2011 Transplant dysfunction in pregnancy • Same causes • Same investigations Slides courtesy of Matt Hall • Different treatment Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Obstruction Nottingham University Hospitals Infection Rejection Medication February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Biopsy if indicated. Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy • Altered pharmacodynamics • Potential teratogenicity Check the BNF Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham Learn what you University Hospitals February 2011 can use Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Immunosuppressants Antihypertensives courtesy of Matt Hall Antibiotics Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides courtesy Antihypertensives of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy 1. Slides courtesy of Matt Hall ACE inhibitors Slides courtesy of Matt Hall Nottingham University Hospitals 2. ARBs February 2011 3. February 2011 1. Labetalol Slides courtesy of Matt Hall Spironolactone Nottingham. Methyldopa Nottingham University Hospitals 4. Aliskiren 2. University Hospitals February 2011 5. Moxonidine 3. Nifedipine 4. Hydralazine Slides courtesy of Matt Hall 6. Minoxidil Nottingham University Hospitals 7. Diltiazem February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Antibiotics Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 1. Trimethoprim of Matt Hall February 2011 1. Cephalosporins Slides courtesy of Matt Hall Slides courtesy 1. Quinolones Nottingham. Penicillins Nottingham University Hospitals (not in 1 st trimester) 2. University Hospitals 2. Tetracyclines February 2011 2. Nitrofurantoin 3. Gentamicin (not in 4. Erythromycin. Slides courtesy of Matt Hall 3 rd trimester) Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Immunosuppressants Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Slides courtesy of Matt Hall 1. Mycophenolate mofetil Nottingham University Hospitals 2. February 2011 1. Prednisolone. February 2011 Slides courtesy of Matt Hall Mycophenolic acid 3. Sirolimus Nottingham. Cyclosporine Nottingham University Hospitals 2. University Hospitals February 2011 4. Methotrexate 3. Tacrolimus 4. Azathioprine Slides courtesy of Matt Hall 5. Cyclophosphamide Slides courtesy of Matt Hall Nottingham University Hospitals 6. ATG / OKT 3 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Rock and roll Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Thanks for listening… Slides courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011