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 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 Conception statistics of 2008. http: //www. statistics. gov. uk/downloads/theme_health/conceptions 2008/conceptions 08. pdf courtesy Matt Hall Slides courtesy of Matt Hall Brown JH, Maxwell AP, Mc. Geown MG. Irish J Med. 2001 Nottingham University Hospitals Barua M, Hladunewich M, Keunun J et al. Nottingham 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 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. Hospitals risks Nottingham University February 2011 Maternal and fetal risks Is pregnancy to of Matt Hall Will I take home a healthy baby? of Matt Hall Slidesgoing courtesy Slides courtesy Nottingham University Hospitals make my kidney disease. University worse? 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 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? 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 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? Nottingham University Hospitals 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 Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham University Hospitals February 2011 February 2011 Neonatal deathofrisk Slides courtesy of Matt Hall Slides courtesy Matt Hall Nottingham University Hospitals Diastolic BP 2011 Absolute risk February 2011 February Slides courtesy of Matt Hall <70 0. 9% Nottingham University Hospitals February 2011 70 -80 3. 2% Blood pressure? Slides courtesy of Matt Hall 80 -90 Nottingham University Hospitals Nottingham 3. 6% University Hospitals February 2011 >90 or. February treated 2011 15. 3% 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 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 • 43 pregnancies in 30 women with CKD Nottingham (serum creatinine 110 to 490 μmol/l) February 2011 • Hypertension was. Slides present from conception in 26 (60%). courtesy of Matt Hall Slides courtesy of Matt Hall • Logistic regression identified uncontrolled an Hospitals Nottingham University Hospitals hypertension at conception Nottingham as University February 2011 independent risk factor for 2011 fetal death Slides courtesy of Matt Hall • RR fetal death with MAP> 105 mm. Hg at. Nottingham conception = 10. 5 Hospitals Nottingham University Hospitals University February 2011 February • Accelerated loss of maternal renal function in 72011 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. of Mattwith Hall BP>140/90 versus 1%Slides of Matt Hall • Perinatal mortality. Slides 33%courtesy in women with courtesy BP<140/90 Nottingham University Hospitals • (Hypertension not. February identified as a risk factor for progression of maternal disease. ) 2011 February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals Jungers P et al. Pregnancy in women with impaired renal function. Clin Nephrol 1997; 47(5): 218 -288 February 2011 1991; 40: 1098 -1102 Abe S. Pregnancy in Ig. A nephropathy. Kidney International

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 ? Baseline renal function yes 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 - 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. OR 1. 9 preterm delivery Second trimester. Slides ACR>3 mg/mmol Nottingham University Hospitals Women without CKD February 2011 trimester OR 4. 7 preterm delivery Slides. Second courtesy of Matt Hall ACR>20 mg/mmol Slides courtesy of Matt Hall Nottingham University Hospitals Diabetes 2011 and hypertension February 2011 February Slides courtesy of Matt Hall Nottingham University Hospitals Proteinuria > 3 g/d February 2011 Proteinuria X Women with CKD Creat > 124μmol /l No impact onof outcome Slides courtesy of Matt Hall Slides courtesy 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 Women with CKD Slides courtesy of Matt Hall pregnancy assoc with 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 2011 February 2011 Hemmelder MH et al. Proteinuria: a risk. February 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 February Imbasciati 2011 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 Slides Matt Hall Yes No courtesypofvalue Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall n 6 Nottingham University Hospitals 21 February 2011 age (years) Mean (SD) February 2011 Maternal 33. 0 (3. 7) 30. 4 (3, 3) 0. 103 Slides courtesy of Matt Hall Median (range) Gravidity 3 (1 -4) 3 (1 -5) 0. 057 Hospitals Nottingham University n (%) February 2011 0. 357 2 (33%) Slides. Underlying courtesy of glomerular Matt Hall disease Slides courtesy of Matt Hall 13 (69%) Proteinuria? Nottingham University Hospitals February 2011 Mean (SD) Baseline serum creatinine (μmol/l) 111 (46) 81 (20) 0. 027 Slides courtesy of Matt Hall Mean (SD) Baseline e. GFR (ml/min) 63 (28) 79 (16) 0. 077 Hospitals Nottingham University Median (IQR) Februaryratio 2011 February Baseline protein: creatinine 29 (206) 46 (272) 2011 0. 345 Slides courtesy of Matt Hall (mg/mmol creatinine) Nottingham University Hospitals February 2011 Median (IQR) Rate of decline in e. GFR prior to 0. 44 (4. 15) -0. 50 (3. 52) 0. 932 conception (ml/min/year) Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Mean (SD) Slides courtesy 143. 1 Slides. Baseline courtesy systolic of Matt Hall 136. 6 BP (mm. Hg) 0. 08 Nottingham University Hospitals Nottingham University (18. 3) Hospitals (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 Nottingham (33. 3%) University 0. 003 Hospitals Nottingham University Hospitals February 2011 of study cohort February 2011 Table. Demographic and clinical parameters

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 February p=0. 86 2011 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 Baseline renal function yes 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 Hospitals Aetiology of kidney disease? 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% Hospitals 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 2011 nephropathy (n=268) 15% 21% 12% Aetiology of kidney disease? t c e f f e f o s e e m c n o e c t d i u v o e n g o n i y c g n i o l v o i n t o ae c o f o N Slides courtesy of Matt Hall MC GN (n=278) 12% Hospitals 9% 2% 7% Nottingham University Hospitals February 2011 Slides. Diabetic courtesynephropathy of Matt Hall (n=97) Slides courtesy of Matt Hall 6% 32% 58% Nottingham University Hospitals February 2011 disease (n=464) February 2011 Polycystic 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 Hallof pregnancy outcomes by aetiology Slides courtesy of Matt Hallfocal segmental Comparison of CKD. FSGS, Nottingham Universityglomerulosclerosis; Hospitals Nottingham University Hospitals 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 SLE Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal February 2011 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 Slides courtesy of Matt Hall 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 Preterm Slides courtesy of Matt Hall labour Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Neonatal morbidity Slides courtesy of Matt Hall and mortality 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. University - yes Hospitals maternal? no Nottingham University Hospitals Nottingham 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 Medicines Blood pressure Pre-eclampsia Thrombo. Nottingham University Hospitals infection prophylaxis management control February 2011 prophylaxis nt treatment Im m un tw osu ea pp ka re ge ss a Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham ma Dia University Hospitals lys nip 2011 February Slides courtesy of Matt Hall ula is 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 Slides courtesy of Matt Hall Slides courtesyreview of Matt Hall Nottingham University Hospitals February 2011 February 375602011 women Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 All women High Slides courtesy of Matt Hallrisk women Nottingham University Hospitals February 2011 17% relative 25% relative Management of CKD and hypertension in pregnancy Pre-eclampsia prophylaxis risk Hall reduction Slides courtesy of Matt Hall risk reduction Nottingham University Hospitals February 2011 NNT =Slides 72 courtesy of Matt Hall 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 Hall 8%February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt 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 Pregnancy Nottingham University Hospitals Nephrotic syndrome February 2011 Slides courtesy. RR of Matt Hall Slides of Matt Hall VTE = 1. 7 RR courtesy VTE = 4. 3 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 risk factors Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals LMWH Nottingham. No University Hospitals Prophylactic treatment February 2011 Management of CKD and hypertension in pregnancy Thrombo-prophylaxis Slides courtesy of Matt Hall Nottingham. If. University Hospitals Nottingham University Hospitals renal impairment, February 2011 monitor Factor. Slides Xa levels Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Low threshold for Slides courtesy of Matt Hall Slides courtesy. VTE of Matt Hall investigating suspected Nottingham University Hospitals February 2011 until 6 weeks Slides courtesy. Treat of Matt Hall 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 Slides courtesy of Matt Hall 4 x increased risk Nottingham University Hospitals February 2011 in pregnancy 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 Slides courtesy of Matt Hallin Nottingham University Hospitals pregnancy reduces the incidence of February 2011 February pyelonephritis by 2011 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 Slides courtesy of Matt Hall indicated to reduce the risk of Nottingham University Hospitals February 2011 pyelonephritis Slides courtesy of Matt Hallin pregnancy… Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Slides courtesy of Matt Hall …Antibiotic treatment of Nottingham University 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 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 8. 3% 7. 7% 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%University Hospitals Nottingham February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 After adjusting for confounding covariates, no increased risk. Slides of preterm or. Hall Slides courtesy of Matt Hall courtesybirth of Matt small infant in women exposed to urinary Nottingham University Hospitals tract infection. 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. In. Matt Hall Slides courtesy of Matt Hall pregnancy Nottingham University Hospitals February 2011 Asymptomatic. Slides bacteruria courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals Non-pyelonephritic February 2011 Treat of Matt Hall February 2011 Slides courtesy of Matt Hall Slides courtesy 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 Second University or more Hospitals episode in pregnancy? Nottingham University Hospitals February 2011 courtesy of Matt Hall Asymptomatic. Slides bacteruria Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Non-pyelonephritic Slides courtesy of Matt Hall Slides courtesy Treat of Matt Hall 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 hypertension 2011 Target February BP <150/100 Chronic Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Do not treat to 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 ? of Matt Hall February 2011 Slides. Chronic courtesy ofhypertension Matt Hall Slides. BP courtesy 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 Slideshypertension courtesy of Matt Hall Slides courtesy of Matt Hall Target BP <140/90 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 Conception statistics of 2008. http: //www. statistics. gov. uk/downloads/theme_health/conceptions 2008/conceptions 08. pdf courtesy Matt Hall Slides courtesy of Matt Hall Brown JH, Maxwell AP, Mc. Geown MG. Irish J Med. 2001 Nottingham University Hospitals Barua M, Hladunewich M, Keunun J et al. Nottingham 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 An average sized. February renal 2011 unit in the UK Pregnancy and dialysis Slides courtesy of Matt Hall would expect to. Hall treat one pregnant patient 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 Boots? 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 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 Serum βh. CG Early. University ultrasound Nottingham University Hospitals Nottingham 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. University ultrasound Nottingham University Hospitals Nottingham Hospitals Serial βh. CG February 2011 February in 2011 1 -2 weeks 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 Increase by 1. 5 kg over first trimester Nottingham University Hospitals February 2011 0. 2 -0. 4 kg/week from. February week 2011 15 Slides courtesy of Matt Hall Weekly clinical evaluation Nottingham University Hospitals February 2011 Bloodofpressure <140/90 Slides courtesy Matt Hall Target blood pressure Slides courtesy of Matt Hall Nottingham University Hospitals Do not treat to DBP<80 mm. Hg February 2011 Pregnancy and dialysis Anaemia ESA requirement increases by 85% at 28 Slides weeks Slides courtesy of Matt Hall Nottingham Hospitals Nottingham University Hospitals Target University Hb 10 -11 g/dl February 2011 Slides courtesy of Matt Hall Nutrition Protein intake >1. 8 g/kg/day Nottingham University Hospitals February 2011 Energy intake 30 kcal/kg/day Slides courtesy of Matt Hall Water soluble vitamin and folic acid supplementation 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 Nottingham University • Fetal growth monitoring every. Hospitals 1 – 2 weeks February 2011 Pregnancy and dialysis • Liquor volume monitoring every 1 -2 weeks Slides courtesy of Matt Hall • CTG monitoring every dialysis session from 25 weeks 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

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 may be lower Nottingham University Hospitals • Infection. February 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 al. Clin J Am 2011 Soc Nephrol 2008; 3: 392 -396

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 al. Clin J Am 2011 Soc Nephrol 2008; 3: 392 -396

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. Nottingham University Hospitals 90% 50% University Hospitals Nottingham February 2011 Slides. IUGR/SGA courtesy of Matt Hall Slides courtesy of Matt Hall 90% 17% Nottingham University Hospitals February 2011 Pre-eclampsia 75% 0% Pregnancy and dialysis courtesy of Matt Hall Perinatal death Slides 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 al. Clin J Am 2011 Soc Nephrol 2008; 3: 392 -396

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 Nottingham University and Hospitals As much dialysis as you can facilitate February 2011 certainly >20 February 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 following University transplant are Nottingham University Hospitals February 2011 vastly better than. February if still on dialysis Slides courtesy of Matt Hall - 95% success 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 University Hospitals Nottingham University Hospitals 1. Nottingham Wait 2 years post-transplant (some say 12 -18 months) February 2011 Slides courtesy of Matt Hall 2. Stable renal function Slides courtesy of Matt Hall Nottingham University Hospitals 3. Minimal proteinuria February 2011 4. Slides Minimal or well-controlled hypertension courtesy of Matt Hall Slides courtesy of Matt Hall University Hospitals Nottingham University Hospitals 5. Nottingham No transplant rejection February 2011 Slides courtesy of Matt Hall 6. Minimal levels of appropriate immunosuppression 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 Nottingham University Hospitals are predicted February 2011 by baseline Slides courtesy of Matt Hall 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 Slides courtesy of Matt Hall 30% Nottingham University Hospitals >125 μmol/l 2011 February 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 University Hospitals impairment develops in 15% of transplant patients 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 born to mothers with a renal Slides courtesy of Matt Hall Nottingham transplant University Hospitals Nottingham University Hospitals do well in general 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 11% incourtesy USA general Slides courtesy of Matt Hall educational needs (cf. Slides of Mattpopulation) 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 Slides courtesy of Matt Hall Slides courtesy Mattcontraindication Hall (caution butofnot to Nottingham University Hospitals radiation exposure) February 2011 Transplant dysfunction in pregnancy • Same causes • Same investigations courtesy of Matt Hall • Different. Slides treatment Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Slides courtesy of Matt Hall University Hospitals. Obstruction Nottingham University Hospitals Infection. Nottingham. Rejection Medication February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Biopsy if indicated. 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 Learn what you February 2011 can use Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Immunosuppressants Antihypertensives Slides courtesy of Matt Antibiotics 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 Slides courtesy of Matt Hall Antihypertensives Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy 1. Slides ACEcourtesy inhibitors Slides courtesy of Matt Hall Nottingham University Hospitals Nottingham 2. University ARBs Hospitals February 2011 3. February Spironolactone Labetalol Slides 1. courtesy of Matt Hall Slides courtesy of Matt Hall Nottingham University Hospitals 4. Aliskiren 2. Methyldopa February 2011 5. Moxonidine 3. Nifedipine 4. Hydralazine Slides courtesy of Matt Hall Slides of Matt Hall 6. courtesy 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 February 2011 Cephalosporins Slides 1. courtesy of Matt Hall Slides courtesy of Matt Hall 1. Quinolones Nottingham University Hospitals (not in 1 st. Nottingham trimester) 2. Penicillins 2. Tetracyclines February 2011 2. Nitrofurantoin 3. Gentamicin Matt Hall in 3 rd trimester) 4. Erythromycin. Slides courtesy of(not 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 February 2011 2. Hall. Mycophenolic acid Prednisolone Slides 1. courtesy of Matt Hall Slides courtesy of Matt Nottingham University Hospitals 3. Sirolimus 2. Cyclosporine 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