by firstname.lastname@example.org (322 Posts), Tue Jul 27, 2010 02:46 pm
The last question is the easiest to answer. A healthy second pregnancy is always possible, since even scenarios with the highest risk factors for superimposed preeclampsia are not much above 50%. The final answer, however, depends on identifying if there is an underlying renal disease (highly probable from the bits of information above) the womanÃ¢â‚¬â„¢s renal function and the presence or absence of hypertension.
Now to the main queries: We need more information here, of course, but the following can be said; if the woman has normal blood pressure and well preserved renal function often defined as a serum creatinine level below 1.4 or a CKD class of 1 or 2 the odds of a successful next pregnancy is high but there will be an increase incidence of a superimposed preeclampsia and a higher risk of premature delivery. Such pregnancies should be managed, if possible, by a maternal fetal medicine subspecialist collaborating with a nephrologist/s when the underlying kidney disease is identified.
Additionally, since in some women urinary protein is not sought routinely, silent renal disease is identified for the first time during pregnancy. However, and we need more information in this case if the woman only became proteinuric when she became hypertensive and was diagnosed as preeclamptic then there is debate on how long the proteinuria persists postpartum. All agree most normalize in the first week to 10 days but small borderline levels can persist. There are anecdotal cases of the proteinuria taking months to abate but those cases too require a good kidney evaluation.