MAZI
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pregnant woman ( 34 wks ) with the HX of chronic renal failure and previous proteinuria come to you with HTN (150/105 ) and edema and headache , you suspect if she has preeclampsia or exacerbation of chronic renal failure , for diagnosis you order ?
1. 24h urin protein
2. dipstick is sufficint
3. uric acid level
4. it is preeclampcia with no need for further lab
plz answer with explanation
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| msyamp
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Answerplease
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| MAZI
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please wait
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| yasmeen
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uric acid level is elevated in preeclampsia so it may help.
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| MAZI
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CORRECT
but if this level increase or normal in preeclapsia??
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| som
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is uric acid level here used to make a diagnosis
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| MAZI
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yes som the correct answer is uric acid level
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| msyamp
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thanks mazi
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| som
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nice que testing the basic skills...keep posting MAZI
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| drk1980
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I think this Q needs to be reviewed properly..
True tht thr is increased uric acid levels in preeclampsia, due to hemoconcentration attributed by diffuse vasospasm(the hallmark of preeclampsia). Also other findings due to this hemoconc are inc BUN, crea, hemoglobin and hematocrit.
However, excacerbated renal failure(point of the Q) also shows hyperuricemia along with all the other renal changes seen in preeclampsia. Additionally advanced renal failure is asso with dec Hb......but iam not sure if Hb is considered for differentiation...? Anyhow, surely uric acid cant be the differentiating point here. its clearly inc in both.
I read up in Kaplan that if preeclampsia is suspected to be superimposed on chronic HTN , then you look for the foll. -A. Documented rising BP B. demonstrated worsening proteinuria or, C. evidence of maternal jeopardy(Headache, epi pain, vision change, dec plt, etc.). So i think practically, the diagnosis is made on these three points.
thanks for posting Mazi, keep them coming.
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| drk1980
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oh i forgot to conclude my post above.
so i argue that the answer should be 4.
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| MAZI
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hi drk1980
it,s point from blueprint
it said that two defference is: when you have a regular pregnancy visit , increase 30 degree for systol and 15 degree for diastol and if you dont have previose blood pressure you order uric acid level, but i dont know why?
another oponion, where r u msyamp?
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| msyamp
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24 hr protein is more specific i think. levels greater than 300mg/d may be due to Preeclampsia..
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| wyvern
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agree with msyamp.....
preeclampsia is development of hypertension in pregnancy with proteinuria > three hundred mgdl in a 24 hr sample with or without edema..... and uric acid is a prognostic indicator in a patient with hypertension in pregnancy which rises even before there is appearance of proteinuria....
Well atleast that s what i learned in med school, but i guess it must be similar for the usmle.......
Edited by wyvern on 07/23/06 - 02:11 AM
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| msyamp
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URIC ACID IS SENSITIVE BUT NOT SPECIFIC TO pREECLAMPSIA
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| drk1980
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Iam sorry, that quote i typed earlier from Kaplan notes, actually talks abt preeclampsia superimposed on chronic HTN. Instead this Q asks abt how to differentiate between a possible preeclampsia and exacerbated preexisting chronic renal failure. In both cases, you'd see proteinuria, even levels greater than 300mg/d.
And both cases can present with hyperuricemia and elevated BP with its asso signs of edema, headache
So frankly, now iam not sure of this Q to begin with!!
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| yasmeen
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in the above sceniario uric acid is practically the correct answer as proteinuria is seen in both cases.and if uric acid is elevated preeclampsia is most probable diagnosis above anything else besides no other option seems to b correct
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| MAZI
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thank you
but another question, whats the cause of increasing level of uric acid?
is it hemococentration , as drk1980 said.
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| msyamp
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no its renal tubular dysfuntion in preeclampsia
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| AAAAA
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High Uric Acid Levels Predict Pre-Term Delivery
Pregnant women and their babies have a higher risk of developing complications if they have high uric acid levels—called hyperuricemia—in conjunction with pregnancy-induced hypertension, according to a University of Pittsburgh study. Women diagnosed with preeclampsia that included hyperuricemia were almost seven times more likely to deliver babies pre-term than other women in the study. On average, they delivered 3.6 weeks earlier than women who had preeclampsia without hyperuricemia. The authors conclude that “Uric acid should be reexamined for clinical and research utility.” The study was published in the online first edition of Hypertension: Journal of the American Heart Association on October 24, 2005
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