spilling protein with normal pressures

[3preemiekidz]

I have type 1 diabetes so I already know that there is some kidney damage. After having my third child my pressures returned to normal (120/70) and I was only spilling trace protein. At my 6 week pp checkup, they found I was spilling protein again. I was sent to a nephrologist to look for underlying causes of my high blood pressures while pregnant and spilling protein. They did a bunch of tests, I was still spilling 2+ protein at the time but my blood pressure was 110/65 in the office and at home was running about the same. The Dr. told me that there is some kidney damage but that he rarely sees it without high blood pressures and there wasn't much he could do unless my blood pressure also shot up. Well, now I find myself pregnant again (after a failed IUD) and am spilling protein again. Pressures are looking good but everyone is afraid I will develop pre-e or HELLP again. With that being said, what would cause me to spill protein but have normal blood pressure readings and is there anything I can do to prevent it from happenning again?

Rebecca
Mom to Audri 3,
Ezra 2,
Liya 1
and #4 EDD 8/1/04
born at 35, 29 and 31 weeks due to Pre-e/HELLP

[expert on call]

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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