Pre-eclampsia — ESENeph MCQ

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HardPregnancy & RenalPre-eclampsiaESENeph

A 33-year-old woman at 28 weeks gestation with known CKD G3a develops worsening proteinuria (uPCR 250 mg/mmol from baseline 30 mg/mmol), BP 155/100 mmHg, and platelets 110 x 10^9/L. ALT is 85 U/L. What is the most likely diagnosis?

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Correct answer: E — Superimposed pre-eclampsia

This pregnant woman with pre-existing CKD has developed new-onset hypertension with significant proteinuria increase, thrombocytopenia, and elevated liver enzymes. This is consistent with superimposed pre-eclampsia (pre-eclampsia developing in a woman with pre-existing CKD/hypertension). NICE NG133 criteria for pre-eclampsia include new hypertension with proteinuria or organ dysfunction after 20 weeks. She does not meet full HELLP criteria yet (no haemolysis markers, no severely elevated LDH).

Reference: NICE NG133 2019 – Hypertension in Pregnancy