Which laboratory finding is expected in a healthy pregnant woman due to increased glomerular filtration rate?
Elevated serum creatinine
Decreased serum creatinine
Increased proteinuria
Decreased glycosuria
The Correct Answer is B
Renal physiology in pregnancy is altered due to increased glomerular filtration rate (GFR), elevated renal plasma flow, and hormonal changes involving progesterone and estrogen. GFR increases by about 50% in early pregnancy, leading to enhanced clearance of creatinine, urea, and uric acid. Normal serum creatinine in non-pregnant adults is 0.6–1.1 mg/dL in women, but in pregnancy, it falls to 0.4–0.7 mg/dL. Mild glycosuria may occur due to reduced tubular reabsorption capacity, and small protein excretion (<300 mg/day) is considered normal. Elevated creatinine in pregnancy suggests renal impairment, not physiological adaptation.
Rationale for correct answer
2. Decreased serum creatinine is expected because increased GFR enhances filtration and clearance. A healthy pregnant woman often shows creatinine levels at the lower end of normal or slightly below, reflecting increased renal function.
Rationale for incorrect answers
1. Elevated serum creatinine is abnormal in pregnancy. It indicates impaired renal function, as physiologically creatinine should be reduced due to increased clearance. A creatinine >1.0 mg/dL in pregnancy is considered concerning.
3. Increased proteinuria beyond 300 mg/day is pathological and suggests preeclampsia or renal disease. Normal pregnancy allows only slight increases due to higher GFR, but not significant proteinuria.
4. Decreased glycosuria is not typical. Pregnancy often produces mild glycosuria due to increased GFR overwhelming tubular reabsorption, not a decrease. Persistent marked glycosuria, however, may indicate gestational diabetes.
Take home points
• GFR rises in pregnancy, lowering serum creatinine, urea, and uric acid levels.
• Elevated serum creatinine in pregnancy suggests renal impairment.
• Proteinuria >300 mg/day is abnormal and diagnostic for preeclampsia.
• Mild glycosuria is common in pregnancy due to tubular reabsorption changes.
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Related Questions
Correct Answer is C
Explanation
Heartburn (pyrosis)occurs in pregnancy mainly due to progesterone-induced relaxationof the lower esophageal sphincter. This hormone lowers smooth muscle tone, allowing gastric acid to reflux into the esophagus. Symptoms include burning sensation behind the sternum, worsened after meals or lying down. Normal lower esophageal sphincter pressure ranges between 10–30 mmHg, but pregnancy reduces it to below 10 mmHg. Risk factors include increased intra-abdominal pressure from the enlarging uterus and delayed gastric emptying. Complications include esophagitis and sleep disturbance.
Rationale for correct answer
3.The presence of heartburn (pyrosis) in pregnancy is directly linked to progesterone’s smooth muscle relaxation, causing reduced lower esophageal sphincter tone and gastric acid reflux. The clinical presentation is a burning retrosternal discomfort, especially worsened after meals or lying supine. This directly aligns with the pathophysiology described.
Rationale for incorrect answers
1.Pica is an abnormal craving for non-nutritive substances like clay or ice. It is associated with iron deficiency anemia, not progesterone-induced smooth muscle relaxation. Its pathophysiology relates to altered dopamine pathways and iron metabolism, not gastrointestinal sphincter tone.
2.Constipation is common in pregnancy but results from decreased intestinal peristalsis due to progesterone and increased water absorption in the colon. It is not caused by relaxation of the lower esophageal sphincter but rather delayed transit time within the intestines.
4.Gingivitis in pregnancy is due to vascular changes and exaggerated inflammatory response to dental plaque under high estrogen and progesterone levels. It involves gum swelling, bleeding, and hyperemia, not esophageal sphincter relaxation.
Take home points
• Progesterone lowers lower esophageal sphincter pressure, leading to gastroesophageal reflux and heartburn.
• Constipation in pregnancy results from delayed intestinal transit, not sphincter relaxation.
• Gingivitis is hormonally mediated gum inflammation, unrelated to esophageal sphincter physiology.
• Pica is associated with iron deficiency anemia, not gastrointestinal smooth muscle tone changes.
Correct Answer is ["A","B","C"]
Explanation
Renal system changes in pregnancyare driven by increased glomerular filtration rate (GFR), elevated renal plasma flow, and progesterone-mediated smooth muscle relaxation. GFR rises by ~50%, lowering serum creatinine (normal pregnancy 0.4–0.7 mg/dL) and blood urea nitrogen (BUN, normal pregnancy ~8–9 mg/dL). The enlarging uterus compresses the bladder causing urinary frequency. Progesterone relaxes ureters and renal pelvis, leading to dilation (hydronephrosis of pregnancy), urinary stasis, and increased urinary tract infection risk. Mild glycosuria is common due to decreased renal tubular reabsorption but does not always indicate gestational diabetes.
Rationale for correct answers
1.GFR increases significantly during pregnancy due to renal vasodilation and higher plasma volume. This enhances clearance of solutes, resulting in decreased serum creatinine and BUN.
2.Urinary frequency is common, especially in the first trimester due to bladder compression by the uterus and again in late pregnancy when the fetal head engages.
3.Dilation of renal pelves and ureters (hydronephrosis of pregnancy) occurs from progesterone-induced smooth muscle relaxation and uterine compression, causing urinary stasis and increased risk of UTI.
Rationale for incorrect answers
4.Serum creatinine and BUN do not increase in pregnancy. Both decrease due to increased GFR. Elevated values indicate abnormal renal function or preeclampsia.
5.Glycosuria is common due to increased filtered glucose load exceeding tubular reabsorptive capacity. It is not diagnostic of gestational diabetes unless persistent and associated with abnormal glucose tolerance testing.
Take home points
• GFR rises by ~50% in pregnancy, lowering creatinine and BUN levels.
• Urinary frequency occurs from uterine pressure on the bladder.
• Hydronephrosis of pregnancy predisposes to urinary tract infections.
• Mild glycosuria is common and not always diagnostic of gestational diabetes.
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