A 25-year-old woman with diabetic kidney disease presents for follow-up because she is pregnant. She is in her first trimester at 8 weeks of gestation. Her BP is 145/90 mm Hg. She denies fever or dysuria, but her primary care physician told her that her urine shows bacteria. Physical exam is negative. Urinalysis is leukocyte esterase and nitrite positive, the white blood cell count is 10/hpf, and there is moderate bacteriuria. The plasma creatinine is 0.5 mg per dL (44.2 mcmol/L). Urinary albumin-to-creatinine ratio is 100 mg per g (11.3 mg/mmol).

Q:   Which of the following treatments is appropriate?

A:   This patient has chronic hypertension (as defined by elevated blood pressure prior to the 20th week of pregnancy). Decreasing the blood pressure below 150/100 mm Hg is associated with fetal harm. Therefore, treatment for blood pressure is undertaken only if blood pressure is greater than 150/100 mm Hg or if there is end-organ damage. Asymptomatic bacteriuria is associated with a risk of pyelonephritis, shock, DIC, AKI, and premature delivery and therefore should be treated in pregnancy. Cephalosporins are used in pregnancy to treat infections and are safe; TMP-SMX and quinolones should be avoided.

A 26-year-old woman gravida 1 para 0 with no medical history presents at 32 weeks of pregnancy for evaluation of proteinuria and hypertension. She states that her blood pressure was previously normal but for the past two weeks has been running around 160/105 mm Hg. She denies chest pain, headaches, visual changes, hematuria, dysuria, or abdominal pain. She has had no seizures. Physical examination is significant for a BP of 155/95 mm Hg, a gravid abdomen, and 1+ bilateral leg edema. Urinalysis shows 2+ protein but is otherwise unremarkable, with no hematuria or casts seen. Urinary albumin-to-creatinine ratio is 600 mg per g (68 mg/mmol). Hemoglobin and hematocrit are 10 g per dL (100 g/L) and 30%, respectively, and the platelet count is 300,000/mm³

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Disorders of Potassium Homeostasis Hematuria Hemodialysis and Peritoneal Dialysis Cystic Renal Diseases Glomerulonephritis Disorders of Calcium/Phosphorus/Magnesium Homeostasis

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