CONSULT ROUNDS: Pre Eclampsia

**Preeclampsia usually begins in the third trimester, but can occur earlier in patients with preexisting renal disease or hypertension; as early as 20 weeks.
** It can also occur postpartum with hypertension, even up to 6 weeks after delivery.
**.It presents with weight gain andedema, particularly of the hands and face, proteinuria and HTN.  Nephrotic syndrome is noted.  Other lab parameters are elevated uric acid, LDH, liver function tests, and can progress to oliguria.  Fatty liver of pregnancy, HELLP syndrome, TMA associated with pregnancy all have to be ruled out.  
** The severe HTN can itself lead to TMA like picture causing schistocytes to be noted on smear, down-trending haptoglobin and hemolysis ensues. 
**There is a fall in renal blood flow and GFR that can lead to hyperuricemia and hypocalciuria as well as acute renal failure.  The acute renal failure is thought to be due to glomerular endotheliosis withswelling of endothelial cells and subendothelial hyaline and fibrin deposition.  Acute tubular necrosis and cortical necrosis can also occur.
**Pulmonary edema can occur due to changes in pulmonary capillary permeability. 
**Hyperreflexia reflects increased nervous system excitability.When preeclampsia is more severe, it can progress to the HELLP syndrome with hemolysis, elevated liver enzymes,and low platelets.
**Due to decreased placental perfusion, fetal growth restriction and oligohydramnios can occur. 


For more information take a look at this review for all.
http://www.ncbi.nlm.nih.gov/pubmed/21240869
http://www.ncbi.nlm.nih.gov/pubmed/17261438