Renal Physiology of Pregnancy

Abstract

Pregnancy involves remarkable orchestration of physiologic changes. The kidneys are central players in the evolving hormonal milieu of pregnancy, responding and contributing to the changes in the environment for the pregnant woman and fetus. The functional impact of pregnancy on kidney physiology is widespread, involving practically all aspects of kidney function. The glomerular filtration rate increases 50% with subsequent decrease in serum creatinine, urea, and uric acid values. The threshold for thirst and antidiuretic hormone secretion are depressed, resulting in lower osmolality and serum sodium levels. Blood pressure drops approximately 10 mmHg by the second trimester despite a gain in intravascular volume of 30% to 50%. The drop in systemic vascular resistance is multifactorial, attributed in part to insensitivity to vasoactive hormones, and leads to activation of the renin-aldosterone-angiostensin system. A rise in serum aldosterone results in a net gain of approximately 1000 mg of sodium. A parallel rise in progesterone protects the pregnant woman from hypokalemia. The kidneys increase in length and volume, and physiologic hydronephrosis occurs in up to 80% of women. This review will provide an understanding of these important changes in kidney physiology during pregnancy, which is fundamental in caring for the pregnant patient.

Pharmacokinetics of Sulfadoxine and Pyrimethamine for Intermittent Preventive Treatment of Malaria During Pregnancy and After Delivery

“…The increase in sulfadoxine clearance observed is consistent with the increase in glomerular filtration rate (GFR) and decreases in proximal tubular reabsorption that occur during pregnancy 22. Unfortunately, creatinine clearance was not available for most of the subjects to confirm this.…”

Type 2 diabetes-associated genetic variants of FTO, LEPR, PPARg, and TCF7L2 in gestational diabetes in a Brazilian population

“…Pregnancy affects essentially all aspects of kidney physiology. Glomerular filtration rate (GFR) increases 50% as compared with nonpregnant levels (35) with subsequent decrease in serum creatinine, urea, and uric acid values (36). Also, increases in glomerular filtration rate and minor increases in urinary albumin excretion have been reported early in the course of diabetes (37,38).…”

A computational model of 1,5-AG dynamics during pregnancy

“…Reabsorption rate may change as a function of time during the third trimester via biological mechanisms such as: (1) protein composition in the nephron (Cheung and Lafayette 2013), (2) changes in endogenous production of 1,5‐AG (Tetsuo et al. 1990), (3) shunting of 1,5‐AG to fetus (Boer et al.…”