one kidney, hypertension, protein in urine?

[expert@preeclampsia.org]

I am 32 weeks 6 days pregnant (2nd pregnancy), on 100 mg of altenolol/day, and 10 mg/procardia (for bp too, put on that a week ago). 1600 mg of mag ox/day (even with that much mag is still low), bp readings of 150's/100's, and last weekly 24 hr urine protein was 730 (will repeat May 6th), and on modified bedrest. the week before 24 hr urine was 499. I can't remember my albumin levels exactly, but they are low too. creatinine was also low this last 24/urine and blood work.

I have one kidney (for over 10 years), stage 2 renal disease, have renal hypertension (when not pregnant it is 100/70 on 50 mg/day altenolol, before any pregnancy i was on an ace inhibitor, dosage was 20 mg/day, but i can't remember what it was), and about 100-200 level of protein in a 24 hr urine.

I live in a very rural area and my ob hasn't had a patient like me before. my nephrologist defers to my ob for my treatment. Do I have pre-eclampsia? Am I receiving good care? I didn't get this bad with first pregnancy (induced at 39 weeks with 830 protein 24 urine and was on 150 mg/day altenolol - bp was 150/90's). I have been seeing my OB 2x/week for the last 2 weeks. He tells me that for me, it's not that bad, and I shouldn't worry, anyone else though, and they would already be delivered.

thank you in advance for listening to me, and hopefully you can provide some reassurance.

[expert@preeclampsia.org]

First it would be of help to know what the underlying renal diagnosis is and the reason this patient has but one kidney. What is important here is that the patient is being evaluated twice a week. In a patient with underlying renal disease who commences pregnancy with some proteinuria, increases in protein excretion per se are not worrisome. But if these increments are accompanied by sudden increases in blood pressure this should be of greater concern. Also, when an renal underlying disease is present, the Nphrologist and Obstetrician should try to keep her blood pressure near normal levels; this differing from care of pregnant women without an underlying kidney diseases where blood pressures are permitted to remain moderately elevated (150s/100s mm) Hg without instituting or increasing drug therapy during gestati0on. This patient seems to be receiving good care as evidenced by her OB physician checking her twice weekly, and presumably having educated her regarding symptoms requiring an immediate phone call or trip to the hospital. He/she is presumably monitoring both fetus and mother closely. While it would be best to be under the care of a high risk OB subspecialist, this can be difficult to achieve in a rural area, and successful MDs in these rural practices tend to be surprising gifted, or else they do not last in solo practices..