Our experts have said that third trimester nausea is an "underappreciated" symptom. Have you gotten the results from your latest bloodwork and 24-hour collection? Your headache and visual disturbances are also concerning to not-a-doc me. How did your weekend go??
To answer your question, my understanding is that yes, you can be sick without having protein in your urine. You aren't technically diagnostic for PE without protein, but the diagnostic criteria are strict only in research - if you're sick, you're sick, and one of my favorite experts noted "we treat people, not diseases".
To get more technical, protein usually shows up later in the disease progression, and studies have shown that the underlying factors that cause the damage we see in PE are elevated up to 5-6 weeks before woman are diagnostic.
To get less technical, we've had women here seize while having "just" high blood pressure. I think Caryn was the one who coined the term "kidneys of steel". Search Caryn's posts, she reads even more than I do and she says a lot about the "umbrella" of hypertensive issues of pregnancy, and how the symptoms manifest differently in different women and due to the mucking around of the underlying factors. Some women can have super high bps but no protein, others have low bp and protein but still have liver failure and HELLP. Other women can have CNS involvement and eclampsia while the rest of their symptoms are relatively mild.
And to get back to the actual diagnostic criteria, I've read waay to much and even I'm confused. Take a look at this old post where I compiled some reading.http://www.preeclampsia.org/forum/viewt ... 10#p341346
Where I'm confused is that, yes, bp and protein are required for PE, but severe PE *seems* to say that you just need *one* of the things on the list, like super high bp. What I'm not clear on is - do you have to be diagnostic for PE and *then* you can diagnose severe PE with another thing on the list? Or is just any one of those "severe" symptoms enough to diagnose severe PE, even without protein?
Okay, I've read the criteria yet again and I think it's the first - "Preeclampsia is considered severe if one or more of the following criteria is present:"
- so you have to at least have a diagnostic amount of protein... but, I'll go back to the "umbrella" of hypertensive disorders of pregnancy and give my not-a-doc guess that you could still be sick.
Remember I'm no doc, but I wonder if you're one of those "kidneys of steel" gals, who actually are very sick but your kidneys just don't show it. You can also have CNS involvement (implied by "the" PE headache, visual disturbances, hyperreflexia) and be a risk of eclampsia without having protein. I'm glad to hear your bloodwork is good! - but you can be sick with PE without bad bloodwork, bad bloodwork is how you know if you have HELLP, a severe and fast-moving form of the disease.
I hope some of that helps - ask again if it doesn't and I'll see if I can grab Caryn!