damage from PE or kidney disorder?

[expert@preeclampsia.org]

First of all, thank you so much for providing this "Ask the Expert Forum"! I appreciate the opportunity to ask you a question.

Four lovely children in six years with preeclampsia in three and still have mild proteinuria 9 mo postpartum

My basic question is: do I have kidney damage from getting preeclampsia 3 times or do I have a disease of the kidney?

I am 36 years old.
Baby #1 2001 girl 40 weeks 6 lb 14 oz term mild PE, no inducing needed, proteinuria was 1440 and bp 140/90 at worst, no complications

Baby #2 2003 boy, 40 weeks, 9 lb 3 oz, no PE at all.

Baby #3 2005 girl 36 weeks induced, 5 lb 4 oz but healthy, PE, urine protein at 3600, blood pressure worst read 160/100, labatolol postpartum for 5 mo.

07/2006 (9 mo postpartum) urine protein/creatinine ratio 0.19 and zero protein found in UA

Baby #4 2007 girl born 37 weeks induced, healthy, protein count 1460, labatolol postpartum 5 mo.

12/2007 24 hour protein 390, on 200 labatolol. Labatolol d/ced 3/08
08/2008 24 hour protein 253, bp 120/78 on no medications

Was blood-tested to rule out Lupus, etc in 2005 and 2007 and came out neg. I have microscopic hematuria too, but my mother and maternal grandmother also have/had it and neither have/had kidney problems (grandma died at almost 90). I think I've had the hematuria since before the babies came!! : )

How likely is it that I have IgA nephropathy? I am quite worried and scared about it. Is it possible that my kidneys were damaged after the pregnancies and are still in recovery?

Also, I am still nursing and have breastfeeding amenorrhea at 10 mo, how can breastfeeding/amenorrhea affect the proteinuria (if known)?

Overall I'm feeling pretty good, can run a 5k in under 30 minutes, I am 5'4" and weigh around 125. No swelling. I'm very health-conscious. Just awfully worried about this!

Please tell me what you think of my above case and my prognosis!!!! Thank you so so much!!!!!! If I was unclear anywhere please email! : ) God bless.

[expert@preeclampsia.org]

Thank you.

There is insufficient evidence here to answer the question with certainty. This patient has had repeat bouts of late pregnancy hypertension and proteinuria during several pregnancies, and intermittent hypertension and proteinuria postpartum. There is also notation persistent hematuria, (with a family history for the latter). No data were mentioned regarding absolute renal function (or creatinine levels) but from the short description one assumes they were sought and the values were normal.

These data all lead up to view that this patient requires an more extensive evaluation from a nephrologist to identify a renal (glomerular) disease here as making an exact diagnoses may lead to different specific therapeutic approaches. From the information given for instance one can but guess if the microscopic hematuria is of the “benign: variety (and this seems to have occurred in other family members), or part of a more serious disease. Thus to summarize, if all standard tests (many already performed) were unrevealing) prove negative a renal biopsy may be in order, though there are some nephrologists who would just watch the patient (with more frequent visits) if her BP had normalized and renal function was normal and stable.