Cases like this are difficult to discuss without access to the patient's records to ascertain what evidence lay behind what the patient was told. Examples here include: the impossibility of making a diagnosis with certainty of IgA nephropathy if a renal biopsy had not been undertaken, as well as a myriad of causes for intermittent brown urine. Nevertheless, the persistence of blood in the urine (presumably microscopic) and qualitative 1+ urine protein, throughout the years, point to an underlying chronic renal problem with a fair chance that it be glomerular in origin (like IgA nephropathy).
The above, the early pregnancy hypertension (130/80 or 90 mm Hg is abnormal at 15 wk), and the pre-pregnancy obesity make this a high risk-pregnancy, meaning the patient might be managed, if possible, by a maternal-fetal-medicine sub-specialist and that a nephrology consultation to hone in on the degree and nature of the renal dysfunction is in order (a number of additional blood and urine test results are needed here). Finally, unlike women with chronic hypertension where treatment of mild or moderate hypertension is debated, establishment of any renal functional loss or evidence of glomerular disease would make it prudent to keep diastolic and systolic pressures below 90 and 140 mm Hg all through pregnancy even if drug therapy is required to do this.
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