Superimposed Pre-eclampsia Assessment — ESENeph MCQ

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ModeratePregnancy & RenalSuperimposed Pre-eclampsia AssessmentESENeph

A 28-year-old woman at 36 weeks gestation with known CKD G3a has a BP of 145/92 mmHg. She has been on Labetalol since early pregnancy. Her urine now shows proteinuria (uPCR 60 mg/mmol, previously 15 mg/mmol). Platelets and liver function are normal. What should happen next?

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Correct answer: E — Assess for pre-eclampsia and plan delivery

New or worsening proteinuria with hypertension after 20 weeks in a woman with pre-existing CKD is suspicious for superimposed pre-eclampsia. NICE NG133 recommends full assessment including bloods (FBC, LFTs, urate, renal function), sFlt-1/PlGF ratio if available, and fetal assessment. At 36 weeks, delivery may be appropriate if pre-eclampsia is confirmed. Pre-existing CKD makes distinguishing CKD progression from pre-eclampsia challenging; the rising proteinuria is the key warning sign. The competing options do not fit the renal phenotype, temporal relationship, treatment threshold or safety constraint described. Management still requires confirmation of current medicines, renal trajectory and relevant contraindications, followed by timely biochemical and clinical reassessment. Escalate urgently if life-threatening electrolyte disturbance, respiratory compromise, shock, neurological deterioration or a dialysis indication develops.

Reference: NICE NG133 2019 – Hypertension in Pregnancy: https://ukkidney.org/health-professionals/guidelines/clinical-practice-guideline-pregnancy-and-renal-disease