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How to take medicine in pregnant women with kidney disease?

admin TAGS: 2017-10-12 16:32

Women undergo a series of physiological changes during pregnancy, such as increased blood volume, glomerular filtration rate (GFR), and increased renal blood flow, resulting in increased burden of the kidneys.The prevalence of chronic kidney disease (CKD) is 3% in women of reproductive age. CKD is not contraindicated in pregnancy, but pregnancy can aggravate the progression of kidney disease. Careful and rational use of drugs during pregnancy is critical to the health and safety of mothers and fetuses. This article summarizes how to use medicine in pregnant women with kidney disease.

Principles of medication for patients with chronic kidney disease

Antihypertensive drugs

CKD pregnancy patients with systolic blood pressure ≥ 160 mmHg and / or diastolic blood pressure ≥ 110 mmHg, 24h urinary protein ≥ 300 mg, accompanied by dizziness, blurred vision, liver and kidney dysfunction, lower extremity edema and other performance, the need for antihypertensive therapy, Decompression target should be maintained at 120-140 / 70-90 mmHg, should not be reduced to low blood pressure to prevent maternal complications and affect placental perfusion. Commonly used antihypertensive drugs include central antihypertensive drugs, β-blockers, calcium channel blockers, α-blockers, the reference dose range and adverse reactions are as follows:

Immunosuppressive agents

Glucocorticoid?

Pregnant CKD patients should be in principle contraindicated in the use of glucocorticoids. To avoid the use of the drugs, such as renal transplantation, lupus nephritis, Henoch Schonlein purpura nephritis, because glucocorticoid can be inactivated placenta hydroxylase, small dose maintenance therapy, but during medication must be rigorous monitoring of mother and fetus.

Chinese medicine

Clinical commonly used are: Tripterygium, rhubarb extract and so on. Due to the presence of gonadal suppression, liver toxicity, bone marrow suppression and other adverse reactions, the current ban on CKD patients with pregnancy.

Results and drafts.32 Results Verticals.

CKD patients with pregnancy, due to lipid-lowering drugs can cause fetal central nervous system malformations, it is now advocated unless severe hyperlipidemia, pregnancy should be avoided.

Anticoagulant

There is no uniform guidelines for anticoagulant therapy, heparin anticoagulant drugs will not pass through the placenta, any form of low-dose heparin can be used in patients with CKD pregnancy; coumarin anticoagulant drugs such as warfarin in organs Development period (6-8 weeks pregnant) can affect organ development, should be avoided; anti-platelet aggregation drugs such as dipyridamole, clopidogrel and so is not recommended.

Anti-inflammatory painkillers

Clinical non-steroidal anti-inflammatory drugs are the most common, these drugs are usually safe, but in the third trimester of the use of NSAIDS can make the arterial catheter premature closure, it should avoid use in the third trimester.

How to take medicine in pregnant women with kidney disease?
How to take medicine in pregnant women with kidney disease?

Other drugs

Pregnancy 12 weeks before the routine should be given folic acid, vitamin B12, to reduce the incidence of preeclampsia, improve the prognosis of pregnancy according to the situation added iron, erythropoietin (HGB maintained at 100-110 g / L) and calcium.

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