Question solution

1. A 30 year female of Chronic nephritis/CRF had a live related renal transplant 1 year back. She seeks your advice regarding future pregnancy. She is receiving Prednisolone, Cellcept and cyclosporine as maintenance immunosuppression . Her BP is well controlled with Enalpril 5mg once daily.

a)      How would u assess her suitability of successful outline of pregnancy what advice would you give?

b)      What if any modification in her current medication is required should she become pregnant?

c)       What complications are expected?

Answere:   Assessment of suitability regarding pregnancy and advice entails:

Assessment of her current renal function, her urine detail report and her course post transplant sofar.

At least 1 year post‐transplantation

 Stable renal function with creatinine <2 mg/dl

No recent episodes of acute rejection

 BP ≤140/90 mmHg on medications

 Proteinuria <500 mg/day

Prednisone ≤15 mg/day Azathioprine ≤2 mg/kg/day

Cyclosporin ≤4 mg/kg/day

 Normal allograft ultrasound

b) Replace cellcept with azathioprin and enalpril with methyldopa. Atenolol and metoprolol can also be given. In severe hypertension nefidipine and hydralazine can be given.

d)     Gestational diabetes, preeclamsia, preterm labour .

 Rate of uti more especially whose primarily renal disease is secondary to Pyelonephritis.