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sFlt1 PlGF Pre-existing CKD Pregnancy — ESENeph MCQ

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HardPregnancy & RenalsFlt1 PlGF Pre-existing CKD PregnancyESENeph

A 28-year-old woman at 32 weeks' gestation presents with BP 158/102 mmHg, proteinuria (uPCR 85 mg/mmol), and platelet count 95 x 10^9/L. She has a known history of IgA nephropathy with baseline proteinuria (uPCR 40 mg/mmol) and eGFR 68 mL/min/1.73m2. Her sFlt-1:PlGF ratio is 185. What does the sFlt-1:PlGF ratio most reliably indicate?

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Correct answer: A — Superimposed pre-eclampsia

An sFlt-1:PlGF ratio >85 has high positive predictive value for pre-eclampsia. In this patient with pre-existing CKD (IgA nephropathy), distinguishing worsening glomerular disease from superimposed pre-eclampsia is challenging clinically. The elevated ratio of 185, combined with new hypertension, worsening proteinuria beyond baseline, and thrombocytopenia, strongly supports superimposed pre-eclampsia rather than IgAN flare alone. This biomarker is particularly valuable in women with pre-existing kidney disease where traditional diagnostic criteria overlap.

Reference: NICE 2019 – NG133 Hypertension in Pregnancy; Zeisler et al 2016 – sFlt-1:PlGF in Pre-eclampsia Prediction