MATERNAL KIDNEY AND URINARY TRACT DISORDERS

During pregnancy, significant physiological changes occur in the maternal kidney and urinary system. The glomerular filtration rate increases, serum creatinine decreases, and protein and glucose excretion in the urine increases. Dilatation of the ureter and renal pelvis leads to physiological hydronephrosis, which is more pronounced on the right side. These structural changes lead to urinary retention, which favors infections. In addition, the increased bladder capacity and the development of vesicoureteral reflux increase the risk of infection. Urinary tract infections are common in pregnant women and are divided into asymptomatic bacteriuria, cystitis, and pyelonephritis. Asymptomatic bacteriuria needs to be treated, as untreated cases can lead to pyelonephritis, preterm birth, and low birth weight. Treatment includes beta-lactams, nitrofurantoin, and fosfomycin. Acute cystitis is a symptomatic disease and should be treated with appropriate antibiotics. Acute pyelonephri-tis can lead to serious maternal complications such as sepsis, acute kidney injury, and Acute Respirato-ry Distress Syndrome (ARDS); in such cases, hospitalization, aggressive fluid therapy, and parenteral antibiotic treatment are required. Nephrolithiasis during pregnancy typically occurs in the second and third trimester. It manifests as flank pain and hematuria. An ultrasound examination is the first choice for diagnosis, and if necessary, magnetic resonance urography can be used. Most stones pass spontaneously with conservative treat-ment, but in some cases surgical intervention may be necessary. Pregnancy after a kidney transplant can be successful under appropriate conditions. However, there is an increased risk of high blood pressure, pre-eclampsia, premature birth and low birth weight. Preg-nancy is generally well tolerated in autosomal dominant polycystic kidney disease, but unfavorable outcomes are more common in the presence of hypertension, and the risk of genetic transmission should be considered. Acute and chronic glomerulonephritis are rare in pregnancy but are associated with hypertension, proteinuria, pre-eclampsia and perinatal loss. The risk of thromboembolism is high in pregnant women with nephrotic syndrome. Pregnant women with chronic kidney disease, have an increased risk of pre-mature birth, fetal growth restriction, and loss of kidney function. Acute kidney damage during preg-nancy usually occurs due to pre-eclampsia, bleeding, sepsis, or obstetric complications. Even small increases in serum creatinine are clinically significant. Early diagnosis and appropriate management are crucial for both maternal and fetal prognosis. In conclusion, renal and urinary tract disorders during pregnancy pose serious risks to maternal and fetal health, and diagnosis and treatment must be carefully monitored and carried out with a multidis-ciplinary approach.