scholarly journals Particular Patterns of the Influence of the Physiology of Normal Pregnancy on the Pharmacokinetics of Drugs in the Liver

2021 ◽  
pp. 256-261
Author(s):  
Eliza Umarovna Khasueva ◽  
Yana Evgenevna Efimova ◽  
Diana Khasanbievna Khatanova ◽  
Leila Ibragimovna Bachieva ◽  
Alina Yurievna Maslova ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Drug Metabolism ◽  
Pregnant Women ◽  
Plasma Proteins ◽  
Filtration Rate ◽  
Hepatic Clearance ◽  
Normal Pregnancy ◽  
Legal Aspects ◽  
Enzyme Systems ◽  
Duration Of Pregnancy

Pregnant women are the most "untouchable" group of people in relation to pharmacological research due to ethical and legal aspects, as well as concerns for the health and integrity of the fetus. And that is why pregnant women practically do not participate in clinical, pharmacodynamic, or pharmacokinetic testing. The mechanisms of teratogenesis are unpredictable, and in this case mutations can occur regardless of the duration of pregnancy and at any level. In women during pregnancy, the activity of liver enzyme systems involved in drug metabolism changes completely, which affects their clearance. This should be taken into account when selecting drugs and dosages for the treatment of various diseases. Our study showed that during pregnancy, a significant decrease in the intrinsic hepatic clearance of the CYP1A2 substrate is enhanced by a decrease in the binding of theophylline to plasma proteins and an increase in the glomerular filtration rate.

scholarly journals Gambaran Kadar Ureum Serum pada Wanita Hamil Normal

2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Muh. A. Hajia ◽  
Arthur E. Mongan ◽  
Mayer F. Wowor
Keyword(s):  
Glomerular Filtration Rate ◽  
Pregnant Women ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Normal Pregnancy ◽  
Hormonal Changes ◽  
Serum Urea ◽  
Plasma Urea ◽  
Functional Changes ◽  
Organ Systems

Abstract: During pregnancy, there are a variety of anatomical, physiological, biochemical, and hormonal changes that greatly affect several organ systems. Functional changes resulted from hormonal changes, increased load due to fetal growth, and ureter obstruction due to uterus enlargement cause increased glomerular filtration rate (GFR) that indicates an increase in renal function. These changes are accompanied by altered plasma concentration of certain substances such as ureum. Increased GFR results in declining plasma urea level. This study was aimed to obtain the serum urea levels in women with normal pregnancy. This was a descriptive observational study. There were 30 blood samples obtained from normal pregnant women in public health centers at Minanga, Bahu, and Sario from October 2017 to November 2017. The results showed that 30 normal pregnant women (100%) had decreased serum urea, as follows: 12.33 mg/dl in the 1st trimester; 9.09 mg/dl in the 2nd trimester; and 11,8 mg/dl in the 3rd trimester. Conclusion: Serum urea of normal pregnant women in the 1st trimester was higher than in the 2nd and 3rd trimester.Keywords: normal pregnancy, urea Abstrak: Selama kehamilan, wanita mengalami perubahan anatomis, fisiologis, biokimia dan endokrin yang sangat memengaruhi beberapa sistem organ. Perubahan fungsi selama kehamilan karena efek hormonal, peningkatan beban dari janin, dan obstruksi ureter oleh rahim yang semakin membesar mengakibatkan peningkatan Glomerular Filtration Rate (GFR) yang merupakan indikasi peningkatan fungsi filtrasi ginjal disertai perubahan konsentrasi plasma. Sebagai hasil dari peningkatan GFR, ureum plasma menurun pada kehamilan. Penelitian ini bertujuan untuk mengetahui gambaran kadar ureum serum pada wanita hamil normal. Jenis penelitian ialah deskriptif observasional. Terdapat 30 sampel darah dari wanita hamil normal di Puskesmas Minanga, Bahu, dan Sario sejak Oktober-November 2017. Hasil penelitian mendapatkan 30 wanita hamil normal (100%) mengalami penurunan kadar serum ureum yaitu 12,33 mg/dl pada trimester I; 9,09 mg/dl pada trimester II; dan 11,8 mg/dl pada trimester III. Simpulan: Ureum serum pada wanita hamil normal trimester 1 lebih tinggi dibandingkan kadar serum ureum trimester 2 dan kadar serum ureum trimester 3.Kata kunci: hamil normal, ureum serum

Renal disease in pregnancy

1989 ◽  
Vol 1 (2) ◽  
pp. 177-192 ◽  
Author(s):  
Priscilla Kincaid-Smith ◽  
Kenneth Fairley
Keyword(s):  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Intimate Relationship ◽  
Physiological Changes ◽  
Anatomical Changes ◽  
The Right ◽  
In Pregnancy

There is an intimate relationship between the kidney and pregnancy. Renal plasma flow increases by 50–70% during a normal pregnancy and the glomerular filtration rate by about 50%.1These changes commence in the first trimester and fall in the last trimester reaching normal levels within about four weeks postpartum. These physiological changes are accompanied by striking anatomical changes which consist of dilatation of the ureter, pelvis and calyces, together with an increase in renal parenchymal size. The dilatation i s more marked on the right and may appear in the first trimester. At term, 90% of pregnant women show this change.2

Renal reserve during human pregnancy

1996 ◽  
Vol 271 (1) ◽  
pp. F16-F20 ◽  
Author(s):  
S. N. Sturgiss ◽  
R. Wilkinson ◽  
J. M. Davison
Keyword(s):  
Glomerular Filtration Rate ◽  
Amino Acid ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Late Pregnancy ◽  
Normal Pregnancy ◽  
Acid Infusion ◽  
Amino Acid Infusion ◽  
Control Infusion ◽  
Healthy Females

Pregnancy in healthy women is associated with increments in glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). We hypothesized that the hyperfiltration of normal pregnancy attenuates or exhausts renal reserve. In 21 healthy females studied serially in early and late pregnancy and then on average 15 wk postpartum, GFR and ERPF were determined by inulin and p-aminohippurate clearances, respectively, before and during either an amino acid infusion (Vamin 9; Kabi Pharmacia) (n = 14) or a control infusion of Hartman's solution (n = 7), both infused at 4 ml/min for 210 min. In early and late pregnancy, GFR increased significantly in response to amino acid infusion [from 137 +/- 29 to 162 +/- 35 ml/min (P < 0.001) and from 134 +/- 29 to 148 +/- 40 ml/min (P < 0.01), respectively], with the increments (18 and 10%, respectively) not significantly different from postpartum (non-pregnant) when GFR increased by 12% from 94 +/- 22 to 105 +/- 23 ml/min (P < 0.002). Amino acid infusion significantly increased ERPF from 874 +/- 188 to 980 +/- 215 ml/min in early pregnancy (P < 0.01), from 684 +/- 135 to 773 +/- 181 ml/min in late pregnancy (P < 0.01), and from 507 +/- 121 to 560 +/- 141 ml/min postpartum (P < 0.006), increments of 12, 13, and 10%, respectively. GFR did not change in response to control infusion. We conclude that, despite gestational increments in renal hemodynamics of > 40%, pregnancy does not attenuate the renal response to amino acid infusion.

scholarly journals .Assessment of Renal Functions among Saudi Arabian Pregnant Women in Jazan Region

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Akram Hamed Awad All Elsukar - Ahmed Mohammed Ahmed
Keyword(s):  
Glomerular Filtration Rate ◽  
Pregnant Women ◽  
Glomerular Filtration ◽  
Plasma Flow ◽  
Filtration Rate ◽  
Renal Plasma Flow ◽  
Saudi Arabian ◽  
Serum Levels ◽  
Control Group ◽  
Renal Functions

Marked renal hemodynamic changes are apparent by the end of the first trimester. Both the Glomerular filtration rate and effective renal plasma flow increase by 50% of pregnant women. Effective renal plasma flow probably increases to a greater extent, and thus, the filtration fraction is decreased during early and mid-pregnancy. Objectives: To assess the serum levels of renal functions among Saudi Arabian Pregnant women in Jazan region. Materials and Methods: a prospective, case- control hospital based study conducted in Jazan region from March 2014– June 2015.30 pregnant women selected in Jazan General Hospital and assessed for renal function tests. 30 healthy subjects selected as control group who were age, and socioeconomic matched to the pregnancy group. SPSS was used for data analysis using student’s ‟t” test and Pearson's correlation for assessment of correlation between different variables. Results: There was a significant difference in the mean of the serum levels of urea and creatinine in test group (p<0.05) when compared to control group with a significant moderate positive correlation between serum levels of creatinine with the period of gestation. Conclusion: Serum levels of urea and creatinine significantly reduced in Saudi Arabian pregnant women. The progressive decrease in the levels of urea and creatinine through the 3 trimesters of pregnancy suggests an increase in Glomerular filtration rate, probably due to increased cardiac output, renal blood flow and changes in fluid distribution.

scholarly journals Effect of pre-eclampsia on glomerular filtration rate in Sudanese women

2017 ◽  
Vol 5 (3) ◽  
pp. 1053 ◽  
Author(s):  
Hind Mamoun Beheiry ◽  
Ibrahim Abdelrhim Ali ◽  
Duria A. M. Rayis ◽  
Amal M Saeed
Keyword(s):  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Normal Pregnancy ◽  
Maternity Hospital ◽  
Urine Creatinine ◽  
The Mean ◽  
Control Study

Background: Creatinine clearance is safest method to measure glomerular filtration rate (GFR) in pregnancy. The objectives was to study a case-control study conducted in Omdurman Maternity Hospital aimed to assess GFR, using creatinine clearance and magnitude of changes of serum creatinine in pre-eclampsia.Methods: Pre-eclamptic were 70, normal pregnant 96 and non-pregnant 63. Investigations were done at St Hellier's hospital London. Serum and urine creatinine were measured using Jaffé reaction and spectrophotometer. 24-hour urine output was measured and creatinine clearance calculated to find GFR. GFR was calculated in ml/min/mm2 using John Hopkins’ method.Results: The mean serum creatinine in pre-eclamptic (68.6µmol/L) was less than non-pregnant (75.5µmol/L) (P=0.001) but was higher than normal pregnant (62.4µmol/L) (P=0.003). Mean GFR pre-eclamptic (68.6ml/min.1.73m2) was less than non-pregnant (87.0ml/min/1.73m2) (P=0.0001) and normal pregnant (89.0ml/min/1.73ml/min/1.73m2) (P =0.0001).Conclusions: GFR decreased at term in normal pregnancy and even more in pre-eclampsia. Serum creatinine levels increased and did not correlate with GFR changes in pre-eclampsia.

Challenges in Managing Pregnancy in Underserved Women with Chronic Kidney Disease

2019 ◽  
Vol 49 (5) ◽  
pp. 386-396 ◽  
Author(s):  
Margarita Ibarra-Hernandez ◽  
Maria de la Luz Alcantar-Vallin ◽  
Angela Soto-Cruz ◽  
Patricia Maria Jimenez-Alvarado ◽  
Francisco Villa-Villagran ◽  
...  
Keyword(s):  
Public Health ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Pregnant Women ◽  
Health Problem ◽  
Filtration Rate ◽  
Public Health Problem ◽  
Estimate Glomerular Filtration Rate

Background: Chronic kidney disease (CKD) is a global public health problem and is linked to adverse outcomes during pregnancy; the high prevalence of CKD (3–6%) in women of childbearing age is of particular relevance in emerging countries where CKD prevalence is higher and resources are limited. Although CKD is a public health problem in Mexico, there is scant information on outcomes in pregnant CKD women in this country. We report maternal–fetal outcomes in a prospective cohort of poor, CKD pregnant women, and compare results with those of pregnant women without CKD. Methods: A prospective study of pregnant CKD women referred to a public obstetrics/nephrology clinic from July 2013 to December 2017; sociodemographic and clinical data, including complications and perinatal outcomes, were recorded. CKD was defined at referral as per KDIGO guidelines; preeclampsia and superimposed preeclampsia were defined as appearance or worsening of hypertension and proteinuria. Findings were compared to official data for ­Mexico and to a historic control of pregnant women without CKD who delivered at our hospital. Results: Sixty-two pregnancies in CKD patients, age 23.4 ± 5.8 years were observed; 46.8% of patients were primiparous. At referral, serum creatinine was 1.8 (1.1–3.0) mg/dL with an estimate glomerular filtration rate (eGFR) of 38.1 (21.9–68.0) mL/min/1.73 m2. In half of the cases, CKD was diagnosed during pregnancy. Forty-eight pregnant women without CKD, age 27 (22–34) years, who delivered during the study period were selected as controls: 33% were primiparous, serum creatinine was 0.50 (0.4–0.6) mg/dL, and estimate glomerular filtration rate was 135 (112–174) mL/min/1.73 m2. Twenty patients needed dialysis (HD-CKD): 2 were already on dialysis, and 18 began treatment during pregnancy; 42 CKD patients did not require dialysis (non-HD CKD). After delivery, 15 patients remained dialysis dependent while 5 did not. Preeclampsia was more frequent in CKD patients in comparison to controls. In total, 93% of CKD patients and 98% of controls delivered a live baby. Prematurity was more frequent in CKD patients than controls and was higher in HD-CKD than in non-HD CKD. Birth weight was lower in CKD when compared to controls. Logistic regression showed a higher risk of preeclampsia in CKD pregnancies than in controls, but it was not affected by age, parity, CKD stage, or need for dialysis during pregnancy. Conclusions: Underserved CKD Mexican women have a high rate of adverse maternal-fetal outcomes during pregnancy. The risk may be higher in patients needing dialysis during pregnancy, many of whom remained dialysis dependent after delivery.

Effect of oral protein loading on renal hemodynamics in human pregnancy

1995 ◽  
Vol 269 (4) ◽  
pp. R888-R895 ◽  
Author(s):  
W. M. Barron ◽  
M. D. Lindheimer
Keyword(s):  
Glomerular Filtration Rate ◽  
Pregnant Women ◽  
Sodium Excretion ◽  
Filtration Rate ◽  
Late Gestation ◽  
Human Pregnancy ◽  
Protein Loading ◽  
Before And After ◽  
Protein Feeding ◽  
Meal Time

Glomerular filtration rate (GFR) and ERPF increase approximately 50% in human pregnancy. To determine if pregnant women have additional “renal reserve,” inulin and p-aminohippurate clearances (Cin, CPAH) were measured in maximally hydrated women before and after a 300-g steak meal, once during late gestation, and again > or = 3 mo postpartum. Protein loading increased Cin [106 +/- 5 (SE) to 119 +/- 4 ml/min, P < 0.003], but not CPAH (587 +/- 35 to 624 +/- 32 ml/min, NS) in the nonpregnant state, but neither clearance was altered during gestation (Cin: 156 +/- 7 to 160 +/- 9.6 ml/min, NS; CPAH: 831 +/- 36 to 899 +/- 37 ml/min, NS). A natriuresis occurred only postpartum (+142 mu eq/min, P < 0.02), which could be explained by the increased GFR alone, since indexes of filtrate delivery and reabsorption (V/GFR, CH2O/GFR, CH2O/V) and fractional sodium excretion changed little. Dopamine excretion, uninfluenced by protein, did not correlate with increments in GFR. A carbohydrate meal (time controls) had no effect on the above described parameters. We make the following conclusions. If protein and pregnancy achieve hyperfiltration by similar mechanisms, these pathways appear “exhausted” in gestation. Also, oral protein loading does not measure maximal renal reserve, since basal GFR in late gestation was substantially greater than that measured after protein feeding in nonpregnant subjects.

scholarly journals PERBANDINGAN KEJADIAN PENINGKATAN TEKANAN DARAH PADA TRIMESTER II BERDASARKAN LAJU FILTRASI GLOMERULUS (LFG)

2019 ◽  
Vol 3 (1) ◽  
pp. 15-26
Author(s):  
Joserizal Serudji ◽  
Rizanda Machmud
Keyword(s):  
Blood Pressure ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Renal Perfusion ◽  
Severe Illness ◽  
Chi Square

During normal pregnancy, glomerolus filtration rate (GFR) is increased so that the concentration of urea and creatinine decreased. With the onset of hypertension in pregnancy, renal perfusion and glomerular filtration decreases, the greater of decline showed more severe illness. This was an observational analytic study with Cohort design and performed in Obgyn Department of M. Djamil Hospital Padang, general district hospital in Batusangkar and Achmad Mukhtar, Private Practice Midwife in Batusangkar from June-December 2014. 100 samples of first trimester of pregnancy, each subject were examined ureum, creatinine, cystatin-c and glomerular filtration rate (GFR) based on CKD-EPI Cystatin and Creatinine 2012 Equation formula. Then divided into two groups, high glomerular filtration rate (GFR) high and low glomerular filtration rate (GFR) group. Each subject was evaluated blood pressure every 3 weeks and statistical analysis was done using the Independent samples test and chi square. There was significant association difference in the levels of urea, creatinine and cystatin-c between high GFR group and low GFR group (p <0.05). There was a statistically significant relationship between low GFR group of pregnant women with changes in systolic and diastolic blood pressure that persists or increases of 5-10 mmHg (p <0.05).Keywords: Preeclampsia, glomerular filtration rate (GFR), ureum, creatinine, cystatin-c, blood pressure

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