UW 4-4: Prego with Diabetic Nephropathy

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UW 4-4: Prego with Diabetic Nephropathy

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DrVirgo
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07/11/07 - 07:31 AM

A 30 year old African American woman with Type 1 DM is found to have a positive pregnancy test. She has a history of diabetic nephropathy and secondary hypertension now treated with Enalapril. Her vitals are stable. Lab studies show BUN of 34mg/dL. and serum Creatinine of 1.8mg/dL. 24 hr urine collection shows protein of 1500mg/day. Which of the following is the most appropriate next step in management?

A. Stop enalapril and start hydralazine
B. Continue enalapril and add methyl dopa
C. Stop enalapril adn start labetalol
D. Stop enalapril and start losartan
E. Stop enalapril and start thiazide diuretic

Please explain your answer. thanks.

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sprint123
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07/11/07 - 07:43 AM

Both Enalapril and losartan is contraindicated in pregnancy and hence we must stop enalapril and add labetalol which is a combined alpha and beta blocker for her nephropathy.

DrVirgo
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07/11/07 - 07:51 AM

Yes, thats right... Labetalol is the DOC for pregnant and Diabetic nephropathy as per UW explanation

However according to Kap, Alpha-methyl dopa is the DOC, and labetalol
and atenolol are good alternatives... BUT they then go on to say that
beta-blockers are associated with IUGR!!!!
confused

Any thoughts on this?

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young_doc
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07/11/07 - 09:45 AM

Labetalol is the DOC for HTN in pregnancy IN THIS CASE, because it also decreases proteinuria & DM nephropathy.

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step3cracker
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07/11/07 - 10:39 AM

we can't continue enalapril so that chice is wrong.

regarding hypertension drug

alpha methyl dopa is good in hypertensive females who become pregnant but there is no choice like that so ,so next best is labetalol.

DrVirgo
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07/13/07 - 12:18 PM

you all are right
But I'm still wondering which is better alpha methyl dopa or labetalol in this case?

so if you had to choose from the following:
1. stop enalapril and start alpha methyl dopa
OR
2. stop enalapril and start labetalol

which one would you choose?

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robin082006
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07/17/07 - 03:11 PM

DrVirgo wrote:
you all are right
But I'm still wondering which is better alpha methyl dopa or labetalol in this case?

so if you had to choose from the following:
1. stop enalapril and start alpha methyl dopa
OR
2. stop enalapril and start labetalol

which one would you choose?

Option 1 is better

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DrVirgo
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07/17/07 - 04:06 PM

I just got another question in UW -->
Basically, it was a question in which there was a + preg test and the woman was taking a beta blocker for migraine prophylaxis.

they said in the explanation:
Beta blockers should be avoided as they decrease placental blood flow and cause growth retardation.

-So WHY do we still use it in a hypertensive pregnant woman?

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