Pregnancy-Associated Kidney Injury

A 23-year-old G1P0000 without prior past medical history is 31 weeks pregnant with prenatal care presents with complaints of worsening leg and face swelling for the past 2 days now seeks care because of headache, diarrhea, nausea, and vomiting. On exam she is found to have a blood pressure of 120/86, edema, and brisk deep tendon reflexes. Laboratory testing revealed hemoglobin 11.3 g/dl, platelet count 141,000/μl white blood count 18,000/μl, creatinine 1.1 mg/dl, aspartate aminotransferases (AST) 65 U/l, lactate dehydrogenase (LDH) 400 U/l, total bilirubin 1.1 mg/dl, prothrombin time (PT) 14.7 s, ammonia of 90 mcg/dl, blood glucose 139 mg/dl, calcium 7.3 mg/dl, and uric acid of 6.0 mg/dl. The urinalysis demonstrated WBC’s 3–5/hpf, RBC’s 3–5/hpf—non-dysmorphic, renal tubular epithelial cells were seen and a urine protein to creatinine ratio of 2. One day after hospitalization the patient’s blood pressure was 145/87 with a similar blood pressure 6 h later.