Gebelikte Renal Hastalıklar
Özet
Gebelik, üriner sistemde tanı ve yönetim açısından bilinmesi gereken önemli yapısal ve fonksiyonel değişikliklere yol açar. Yapısal olarak böbrek boyutları, üreter dilatasyonu ve mesane kapasitesinde azalmalar görülürken; fonksiyonel olarak glomerüler filtrasyon hızı (GFR) ve renal plazma akımı artar. GFR artışına bağlı olarak serum kreatinin ve üre seviyeleri düşer, elektrolit ve protein atılımı ise artar. Gebelikte üriner sistem enfeksiyonları, akut sistit ve septik şoka yol açabilen akut piyelonefrit gibi tablolar yaygındır; tedavilerinde ampirik antibiyotikler ve hidrasyon ön plandadır. Renal kolik ve taş hastalıklarında (nefrolitiyazis) ultrasonografi ilk tarama yöntemidir. Otozomal dominant polikistik böbrek hastalığı gebelikte nadir görülse de hipertansiyon riskini artırır. Glomerüler hastalıklar ile kronik böbrek hastalığı; preeklampsi, preterm doğum ve fetal gelişim kısıtlılığı gibi ciddi perinatal risklerle ilişkilidir. Akut renal hasar ise prerenal, renal ve postrenal nedenlerle tetiklenebilir. Son dönem böbrek yetmezliği olan diyaliz hastalarında multidisipliner yönetim ve artırılmış diyaliz sıklığı gerekirken, renal transplantasyon hastalarında gebelik sonuçları daha başarılıdır. Ancak immünosupresif tedavi seçimi (mikofenolatın teratojenik etkisi nedeniyle siklosporin veya takrolimus kullanımı) kritik öneme sahiptir.
Pregnancy leads to significant structural and functional changes in the urinary system that are crucial to understand for proper diagnosis and management. Structurally, an increase in kidney size, ureteral dilatation, and a decrease in bladder capacity are observed, while functionally, the glomerular filtration rate (GFR) and renal plasma flow increase. Due to the elevated GFR, serum creatinine and urea levels decrease, whereas the excretion of electrolytes and protein increases. Urinary tract infections, acute cystitis, and acute pyelonephritis, which can cause septic shock, are common during pregnancy; empirical antibiotics and hydration are primary in their treatment. Ultrasonography is the first-line screening tool for renal colic and stone diseases (nephrolithiasis). Autosomal dominant polycystic kidney disease is rarely encountered during pregnancy but increases the risk of hypertension. Glomerular diseases and chronic kidney disease are associated with severe perinatal risks such as preeclampsia, preterm birth, and fetal growth restriction. Acute kidney injury can be triggered by prerenal, renal, and postrenal factors. End-stage renal disease patients on dialysis require multidisciplinary management and increased dialysis frequency, whereas pregnancy outcomes are more successful in renal transplant recipients. However, the selection of immunosuppressive therapy is critical, favoring cyclosporine or tacrolimus due to the teratogenic effects of mycophenolate.
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