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Summary of renal changes in normal pregnancy

Summary of renal changes in normal pregnancy
Parameter Alteration Clinical relevance
Kidney size Approximately 1 cm longer on radiograph.[1] Size returns to normal postpartum.[2]
Ureteral dilation Resembles hydronephrosis on sonogram (more marked on right).[3] Can be confused with obstructive uropathy; retained urine leads to collection errors; renal infections are more virulent.
Renal function Glomerular filtration rate and renal plasma flow increase approximately 50%.[4] Serum creatinine decreases during normal gestation; creatinine >0.8 mg/dL (>72 micromol/L) should be considered abnormal; protein, amino acid, and glucose excretion all increase.[5-7]
Acid-base balance Hyperventilation and respiratory alkalosis due to progesterone stimulation of respiratory center. Renal bicarbonate excretion increases appropriately.[7] PCO2 decreases to 27 to 32 mmHg; serum bicarbonate decreases to 22 mmol/L; pH remains in high-normal range.[7]
Plasma osmolality Osmotic thresholds for AVP release and thirst decrease; metabolic clearance of AVP increases. Serum osmolality decreases 10 mOsm/L (serum Na approximately 5 mEq/L) during normal gestation; increased placental metabolism of AVP may cause transient diabetes insipidus during pregnancy.
AVP: vasopressin; IVP: intravenous pyelography; PCO2; partial pressure carbon dioxide.
References:
  1. Bailey RR, Rolleston GL. Kidney length and ureteric dilatation in the puerperium. J Obstet Gynaecol Br Commonw 1971; 78:55.
  2. Odutayo A, Hladunewich M. Obstetric nephrology: renal hemodynamic and metabolic physiology in normal pregnancy. Clin J Am Soc Nephrol 2012; 7:2073.
  3. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol 1988; 27:249.
  4. Davison JM, Dunlop W. Renal hemodynamics and tubular function normal human pregnancy. Kidney Int 1980; 18:152.
  5. Kattah A, Milic N, White W, Garovic V. Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia. Am J Physiol Regul Integr Comp Physiol 2017; 313:R418.
  6. Alto WA. No need for glycosuria/proteinuria screen in pregnant women. J Fam Pract 2005; 54:978.
  7. Maternal physiology. In: Williams Obstetrics, 24th ed, Cunningham FG, Leveno KJ, Bloom SL, et al (Eds), McGraw-Hill Education, 2014. p.63.
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