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Pre-eclampsia Diagnosis sFlt1 PlGF CKD — ESENeph MCQ

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ModeratePregnancy & RenalPre-eclampsia Diagnosis sFlt1 PlGF CKDESENeph

A 35-year-old woman with CKD G3a from reflux nephropathy is 36 weeks pregnant. Her eGFR has been stable throughout pregnancy. She develops new proteinuria (uPCR 100 mg/mmol, previously 20). Her BP is 135/85 on Labetalol. FBC and LFTs are normal. sFlt-1/PlGF ratio is 55 (elevated). What is the likely diagnosis?

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Correct answer: C — Pre-eclampsia – new proteinuria with hypertension after 20 weeks in a woman with risk factors; elevated sFlt-1/PlGF ratio (>38) supports the diagnosis even without severe features

New or worsening proteinuria with hypertension after 20 weeks gestation, particularly in a woman with CKD (a high-risk factor for pre-eclampsia), is pre-eclampsia until proven otherwise. The sFlt-1/PlGF ratio >38 has high positive predictive value for pre-eclampsia. NICE NG133 recommends PlGF-based testing between 20-36+6 weeks to aid diagnosis. At 36 weeks with confirmed pre-eclampsia, delivery planning should begin. The challenge of distinguishing CKD progression from superimposed pre-eclampsia is a common clinical dilemma – biomarkers and clinical trajectory help.

Reference: NICE NG133 2019; PROGNOSIS Study – NEJM 2016