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Presentation on theme: "Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Slides."— Presentation transcript:

1 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal Disease and Pregnancy Matt Hall Nottingham Renal Unit SpR Club Belfast

2 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Sex Drugs Rock and roll

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 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 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 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 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 Sex

4 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ? National Statistics Online. Conception statistics Brown JH, Maxwell AP, McGeown MG. Irish J Med Barua M, Hladunewich M, Keunun J et al. Clin J Am Soc Nephrol. 2008;3:392/396 Pregnancy and CKD

5 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and CKD Approximate number of pregnancies per year in UK

6 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Maternal and fetal risks Maternal risks Is pregnancy going to make my kidney disease worse? Fetal risks Will I take home a healthy baby?

7 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Maternal and fetal risks

8 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Baseline renal function?

9 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function?

10 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function?

11 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 p=0.027 Baseline renal function?

12 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Baseline renal function? * * **

13 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Baseline renal function - yes Baseline blood pressure?

14 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Blood pressure? Neonatal death risk Diastolic BPAbsolute risk <700.9% % % >90 or treated15.3%

15 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Blood pressure? p=0.08 p=0.009

16 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Blood pressure? 43 pregnancies in 30 women with CKD (serum creatinine 110 to 490 μmol/l) Hypertension was present from conception in 26 (60%). Logistic regression identified uncontrolled hypertension at conception as an independent risk factor for fetal death RR fetal death with MAP> 105mmHg at conception = 10.5 Accelerated loss of maternal renal function in 7 patients, all of whom had hypertension 168 pregnancies in 118 women with IgA nephropathy. Perinatal mortality 33% in women with BP>140/90 versus 1% with BP<140/90 (Hypertension not identified as a risk factor for progression of maternal disease.) Jungers P et al. Pregnancy in women with impaired renal function. Clin Nephrol 1997;47(5): Abe S. Pregnancy in IgA nephropathy. Kidney International 1991;40:

17 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Baseline renal function - yes Baseline blood pressure - yes Proteinuria ?

18 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Proteinuria Women without CKD Second trimester ACR>3mg/mmol Second trimester ACR>20mg/mmol OR 1.9 preterm delivery OR 4.7 preterm delivery X Diabetes and hypertension Franceschini N et al. Maternal urine albumin excretion and pregnancy outcome. Am J Kindy Dis. 2005’45(6): Jones DC, Hayslett JP. Outcome of pregnancy in women with moderate or severe renal insufficiency. New Engl J Med 1991;336(4): Hemmelder MH et al. Proteinuria: a risk factor for pregnancy-related renal function decline in primary glomerular disease? A,m J Kidney Dis 1995;2691): Women with CKD Creat > 124μmol /l Proteinuria > 3g/d Proteinuria < 3g/d No impact on outcome Women with CKD Pregnancy (n=19) No pregnancy (n=31) Proteinuria and pregnancy assoc with PALRF

19 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Proteinuria? Imbasciati E et al. AJKD 2007;49:753

20 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Proteinuria? PALRF YesNop value n621 Maternal age (years) Mean (SD) 33.0 (3.7)30.4 (3,3)0.103 Gravidity Median (range) 3 (1-4)3 (1-5)0.057 Underlying glomerular disease n (%) 2 (33%)13 (69%)0.357 Baseline serum creatinine (μmol/l) Mean (SD) 111 (46)81 (20)0.027 Baseline eGFR (ml/min) Mean (SD) 63 (28)79 (16)0.077 Baseline protein:creatinine ratio (mg/mmol creatinine) Median (IQR) 29 (206)46 (272)0.345 Rate of decline in eGFR prior to conception (ml/min/year) Median (IQR) 0.44 (4.15)-0.50 (3.52)0.932 Baseline systolic BP (mmHg) Mean (SD) (18.3) (20.8) 0.08 Baseline diastolic BP (mmHg) Mean (SD) 81.0 (4.7)71.6 (9.7)0.009 Receiving antihypertensives n (%) 5 (83.3%)7 (33.3%)0.003 Table. Demographic and clinical parameters of study cohort

21 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Proteinuria p=0.60 p=0.86 p=0.03

22 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Baseline renal function - yes Baseline blood pressure - yes Proteinuria maternal? no fetal? yes Aetiology of kidney disease?

23 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of kidney disease? Perinatal loss Preterm delivery Renal function decline Permanent blood pressure increase FSGS (n=85)23%32%13%10% Membranous GN (n=110)4%35%3% IgA nephropathy (n=268)15%21%12% MC GN (n=278)12%9%2%7% Diabetic nephropathy (n=97)6%36%32%58% Polycystic disease (n=464)3%10%3%14% Reflux nephropathy (n=137)7%15%0.7%11% Comparison of pregnancy outcomes by aetiology of CKD. FSGS, focal segmental glomerulosclerosis; GN, glomerulonephritis; MC, mesangiocapillary. No convincing evidence of effect of aetiology on outcomes

24 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of kidney disease? SLE Hypertension Medication Anti-Ro antibodies Antiphospholipid syndrome Renal dysfunction All associated with adverse outcomes Not the “SLE” label itself

25 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of kidney disease? Reflux nephropathy Increased risk of pyelonephritis Maternal mortality Preterm labour Neonatal morbidity and mortality Increased risk of UTI

26 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of kidney disease? Diabetes

27 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aetiology of renal disease?

28 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Factors associated with adverse outcomes Baseline renal function - yes Baseline blood pressure - yes Proteinuria maternal? no fetal? yes Aetiology of kidney disease – not really

29 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Hawk-like observation Masterful inactivity

30 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD in pregnancy Limited interventions Medicines management Blood pressure control Pre-eclampsia prophylaxis Thrombo- prophylaxis Urinary tract infection treatment Timing of delivery Preconception counselling Immunosuppressant tweakage Dialysis manipulation

31 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Pre-eclampsia prophylaxis

32 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Aspirin 75mg od Systematic review women All women 17% relative risk reduction High risk women 25% relative risk reduction NNT = 72NNT = 19 Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst.Rev Apr 18;(2)(2):CD Preterm delivery RRR 8% Perinatal death RRR 14% SGA RRR 10% Management of CKD and hypertension in pregnancy Pre-eclampsia prophylaxis

33 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Not evidence based Different practices between (and within) centres. Management of CKD and hypertension in pregnancy Thrombo-prophylaxis Nephrotic syndrome RR VTE = 1.7 Pregnancy RR VTE = 4.3 ? Heavy proteinuria RR VTE = ? Pregnancy RR VTE = 4.3

34 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Thrombo-prophylaxis Add-up risk factors Prophylactic LMWH No treatment Treat until 6 weeks postpartum If renal impairment, monitor Factor Xa levels Low threshold for investigating suspected VTE

35 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Asymptomatic bacteruria Pyelonephritis 4x increased risk in pregnancy 21% risk of progression if untreated Treatment of asymptomatic bacteruria in pregnancy reduces the incidence of pyelonephritis by 75%

36 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection …Antibiotic treatment of asymptomatic bacteruria is indicated to reduce the risk of pyelonephritis in pregnancy… Based on studies from s …Antibiotic treatment of asymptomatic bacteruria was associated with a reduction in the incidence of low birth weight babies (RR 0.66 ( ))…

37 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Asymptomatic bacteruria Pyelonephritis Non-pyelonephritic UTI Preterm birth 7.2% Preterm birth 7.7% Preterm birth 8.3% Small for gestational age 16.1% Small for gestational age 16.5% Small for gestational age 18.9% n=85,484 After adjusting for confounding covariates, no increased risk of preterm birth or small infant in women exposed to urinary tract infection. Chen YK et al. Acto Obstet Gynecol Scand 2010;89(7):

38 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Urinary tract infection Asymptomatic bacteruria Pyelonephritis Non-pyelonephritic UTI In pregnancy Treat Asymptomatic bacteruria Pyelonephritis Non-pyelonephritic UTI Treat Second or more episode in pregnancy? Prophylaxis

39 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Blood pressure control

40 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Management of CKD and hypertension in pregnancy Blood pressure control Chronic hypertension Target BP <150/100 Chronic hypertension + CKD Target BP <140/90 Do not treat to DBP<80mmHg Chronic hypertension + proteinuric CKD Target BP ? and treat with what?

41 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Chronic hypertension + proteinuric CKD Target BP <140/90 Management of CKD and hypertension in pregnancy Blood pressure control

42 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 ? National Statistics Online. Conception statistics Brown JH, Maxwell AP, McGeown MG. Irish J Med Barua M, Hladunewich M, Keunun J et al. Clin J Am Soc Nephrol. 2008;3:392/396 Pregnancy and dialysis

43 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis An average sized renal unit in the UK would expect to treat one pregnant patient on dialysis every four years

44 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 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 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 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 Nottingham University Hospitals 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? Amenorrhoea?Pregnancy test from Boots?

45 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 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 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 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 Nottingham University Hospitals 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? Intradialytic hypotension? Serum βhCG Early ultrasound Elevated Serum βhCG but no fetal heart beat? Serial βhCG Repeat ultrasound in 1-2 weeks

46 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Target weightIncrease by 1.5kg over first trimester kg/week from week 15 Weekly clinical evaluation Blood pressureTarget blood pressure <140/90 Do not treat to DBP<80mmHg AnaemiaESA requirement increases by 85% at 28 weeks Target Hb 10-11g/dl NutritionProtein intake >1.8g/kg/day Energy intake 30kcal/kg/day Water soluble vitamin and folic acid supplementation

47 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Befriend an obstetrician Fetal growth monitoring every 1 – 2 weeks Liquor volume monitoring every 1 -2 weeks CTG monitoring every dialysis session from 25 weeks

48 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis PD? Yes! Conception rates may be lower Infection rates no higher No contraindication to Caesarean

49 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis HD? Yes! How much?

50 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis

51 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Hou S. Hemodialysis International 2004;8: p<0.05

52 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Hou S. Hemodialysis International 2004;8:

53 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Hou S. Hemodialysis International 2004;8: Barua M et al. Clin J Am Soc Nephrol 2008;3:

54 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Hou S. Hemodialysis International 2004;8: Barua M et al. Clin J Am Soc Nephrol 2008;3:

55 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis Historic observationsNocturnal HD Preterm delivery90%50% IUGR/SGA90%17% Pre-eclampsia75%0% Perinatal death50%17% Williams D, Davison J. BMJ 2008;336: Barua M et al. Clin J Am Soc Nephrol 2008;3:

56 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Pregnancy and dialysis As much dialysis as you can facilitate and certainly >20 hours/week Maintain pre-dialysis urea < 15mmol/l How much?

57 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Fertility returns within 1 -2 months of transplant Transplant and pregnancy

58 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal disease and pregnancy – renal transplant Pregnancy outcomes following transplant are vastly better than if still on dialysis - 95% success General guidelines 1.Wait 2 years post-transplant (some say months) 2.Stable renal function 3.Minimal proteinuria 4.Minimal or well-controlled hypertension 5.No transplant rejection 6.Minimal levels of appropriate immunosuppression

59 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal disease and pregnancy – renal transplant Pregnancy outcomes are predicted by baseline kidney function Baseline creatinineComplicated pregnancy Successful outcome <125 μmol/l30%97% >125 μmol/l82%75% Persistent post pregnancy kidney function impairment develops in 15% of transplant patients

60 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Renal disease and pregnancy – renal transplant; children Children born to mothers with a renal transplant do well in general Complications are due mainly to preterm delivery and low birth weight Overall, 16% of children have special educational needs (cf. 11% in USA general population)

61 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Transplant dysfunction in pregnancy Same causes Same investigations (caution but not contraindication to radiation exposure) Different treatment Infection Rejection Obstruction Medication Biopsy if indicated.

62 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs

63 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Altered pharmacodynamics Potential teratogenicity Check the BNF Learn what you can use Immunosuppressants Antibiotics Antihypertensives

64 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Antihypertensives 1.Labetalol 2.Methyldopa 3.Nifedipine 4.Hydralazine 1.ACE inhibitors 2.ARBs 3.Spironolactone 4.Aliskiren 5.Moxonidine 6.Minoxidil 7.Diltiazem

65 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Antibiotics 1.Cephalosporins 2.Penicillins 3.Gentamicin 4.Erythromycin 1.Quinolones 2.Tetracyclines 1.Trimethoprim (not in 1 st trimester) 2. Nitrofurantoin (not in 3 rd trimester)

66 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Drugs, CKD and pregnancy Immunosuppressants 1.Prednisolone 2.Cyclosporine 3.Tacrolimus 4.Azathioprine 1.Mycophenolate mofetil 2.Mycophenolic acid 3.Sirolimus 4.Methotrexate 5.Cyclophosphamide 6.ATG / OKT3

67 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Rock and roll

68 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

69 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011

70 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 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 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 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 Nottingham University Hospitals February 2011 Slides courtesy of Matt Hall Nottingham University Hospitals February 2011 Thanks for listening…


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