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Post-Partum Persistent TMA aHUS — ESENeph MCQ

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HardPregnancy & RenalPost-Partum Persistent TMA aHUSESENeph

A pregnant woman with CKD has increasing dipstick protein. What is the recommended method for formal quantification?

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Correct answer: DUse a spot urine protein-creatinine ratio or albumin-creatinine ratio

The best answer is “Use a spot urine protein-creatinine ratio or albumin-creatinine ratio”. The UK guideline quantifies proteinuria in pregnancy with spot PCR or ACR. This is practical, sufficiently accurate for clinical decisions and avoids delay and collection error from 24-hour urine. “Require a 24-hour urine collection before acting” is less appropriate because the UK renal-pregnancy guideline states that 24-hour collection is not required for quantification “Use dipstick grade as the definitive quantitative result” is less appropriate because dipstick testing is influenced by urine concentration and is insufficient for formal quantification “Use serum albumin as a substitute for urinary protein measurement” is less appropriate because serum albumin is affected by pregnancy and inflammation and does not quantify proteinuria “Use creatinine-based eGFR to estimate protein excretion” is less appropriate because eGFR estimates filtration and is not valid in pregnancy, while it does not measure urinary protein

Reference: UK clinical practice guideline on pregnancy and renal disease: https://pmc.ncbi.nlm.nih.gov/articles/PMC6822421/