by expert on call (297 Posts), Fri May 14, 2004 02:13 pm
The diabetic patient: She is correct. Though, microalbuminuria may be present early, frank (dipstick or quantitative proteinuria) is unusual with such levels of blood pressure. There are cases, however where proteinuria has occurred in diabetics entering pregnancy with minimal nephropathy that has persisted after exacerbating during gestation, either due to superimposed preeclampsia, or progression of the nephropathy, but this too is unusual in patients with pressures of 110/65 mm Hg.
In this case, it would be of interest to know how much protein the patient is excreting. Qualitative measures are notoriously insensitive, and even 2+ has been associated with normal excretion in a timed (e.g.,24h) collection. Also a patient who has even minimal diabetic nephropathy complicated by proteinuria should have quantitative excretion checked at 3mos as before then the preeclampsia component may not have regressed fully. It should also be noted that diabetic patients can have other underlying renal diseases and it is just the patient with very normal blood pressure spilling excess protein the should be evaluated further preferably by a nephrologists. Finally, with this patient's history, the probability of preeclampsia recurrence is about one in four, but no one can predict if it will be mild or severe. Management by a high-risk specialist with frequent checks is recommended.
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