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Pre-eclampsia in CKD/SLE — ESENeph MCQ

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HardPregnancy and Kidney DiseasePre-eclampsia in CKD/SLEESENeph

A 29-year-old woman with lupus nephritis in remission at 28 weeks' gestation presents with hypertension and proteinuria. Creatinine is 92 micromol/L, platelets are 96 x 10^9/L and ALT is 86 IU/L. Complement levels are normal and anti-dsDNA is unchanged from baseline. What is the most likely diagnosis?

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Correct answer: A — Pre-eclampsia

Hypertension after 20 weeks with thrombocytopenia and elevated ALT supports pre-eclampsia, while stable complement and anti-dsDNA make lupus flare less likely. Lupus flare more often has rising anti-dsDNA, falling complement and active urinary sediment. Acute fatty liver usually presents with hypoglycaemia, coagulopathy and more severe systemic illness. The pearl is that angiogenic markers and multidisciplinary review can help distinguish pre-eclampsia from renal disease flare.

Reference: UKKA Pregnancy and Renal Disease Guideline; NICE NG133 Hypertension in Pregnancy