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Proteinuria Greatest Pregnancy Risk CKD — ESENeph MCQ

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ModeratePregnancy & RenalProteinuria Greatest Pregnancy Risk CKDESENeph

A 28-year-old woman at 12 weeks' gestation has CKD G3a (eGFR 48 mL/min/1.73m2) secondary to reflux nephropathy. She was previously on ramipril and atorvastatin, both stopped at conception. Her BP is 142/88 mmHg. She is concerned about risks. What is the single greatest risk factor for adverse pregnancy outcomes in women with CKD?

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Correct answer: B — Presence of proteinuria greater than 1 g/day

In women with CKD, proteinuria >1 g/day at baseline or early pregnancy is the strongest independent predictor of adverse maternal and fetal outcomes including preterm delivery, fetal growth restriction, pre-eclampsia, and accelerated CKD progression. The Bramham et al 2011 and Piccoli et al 2015 studies demonstrated that heavy proteinuria outweighs eGFR, BP, or CKD aetiology as a risk predictor. While all these factors contribute, proteinuria >1 g/day confers the highest independent risk. This underscores the importance of pre-conception optimisation of proteinuria with RASi (stopped for pregnancy) and close monitoring.

Reference: https://guidelines.ukkidney.org