by expert on call (297 Posts), Tue Mar 02, 2004 08:12 am
There is little to do to decrease proteinuria, other than increased rest (protein excretion is greatest in the upright position, and least when we are lying down). But this is a functional change that has nothing to do with degree of disease, so do not focus on the protein, but on what is outlined below.
Of importance here is that this patient would benefit from closer scrutiny than a scheduled visit in one month. If hypertension (140/90 mm Hg) with abnormal urinary protein levels (0.6 gm/d) are present the following is recommended.
1) Blood work for a “preeclampsia test baseline" (e.g., Hb or Hct, platelet count, creatinine, uric acid, albumin, lactic acid dehydroginase, transaminase, bilirubin). These tests are repeated periodically depending on clinical circumstance and help in the early detection of progressive kidney function loss, and early biochemical signs of worsening preeclampsia, especially the HELLP syndrome.
2) In situations like this the blood pressure is generally checked every 2 wks, at least, and not a month later. Tests of fetal well being are started as per the Obstetrician's practice with all high risk pregnancies and include fetal monitoring (usually started at 30 or 32 wks), and periodic assessment of fetal growth. Today many maternal fetal medicine specialists perform doppler ultrasound studies of the uterine vessels too, but that is out of my expertise. In sum, a patient with hypertension and proteinuria at 27 weeks must be followed closely.
Finally, I was intrigued as to why the patient was drinking an extra gallon of water a day. Some do this to “wash" the kidneys, which of course one can not. It may also represent increased thirst. If this is the case one would want to know if the patient was making a lot more urine, as there is an unusual complication in pregnancy where patients lose their ability to concentrate their urine, make loads of it, and get quite thirsty. It can be associated with preeclampsia and HELLP syndrome, but usually more severe disease.
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