Nephrology Consultation Note
HPI:
26-year-old primigravida at 30 weeks’ gestation admitted under Obstetrics with severe preeclampsia, severe IUGR with previously absent end-diastolic flow, and vulval cellulitis. Nephrology consulted after incidental ultrasound finding of bilateral enlarged polycystic kidneys. Ultrasound also showed bilateral pleural effusions, free fluid in Morrison’s pouch, massive ascites, and reduced liquor. RCC referral was declined. Currently asymptomatic from a renal perspective with preserved urine output via Foley catheter.
O/E:
BP 159/101 mmHg (received labetalol 100 mg PO and IV labetalol 20 mg + 40 mg).
General condition stable. Chest clear. CVS normal. Abdomen soft with clinically evident ascites. Bilateral LL edema. Foley catheter in situ with good urine output.
Labs:
Cr 63 µmol/L, BUN 10 mmol/L, Na 142 mmol/L, K 4.81 mmol/L.
Albumin 26 g/L, Total protein 4.7 g/dL.
Hb 11.6 g/dL, Plt 323 ×10⁹/L.
AST/ALT normal.
Assessment:
Severe preeclampsia with uncontrolled hypertension.
Third-spacing (massive ascites and bilateral pleural effusions), likely secondary to severe preeclampsia with hypoalbuminemia.
Bilateral polycystic kidneys with preserved renal function; likely ADPKD requiring outpatient evaluation.
No evidence of AKI or indication for dialysis.
Plan:
Continue BP control as per Obstetrics severe hypertension protocol (target SBP 140–150 mmHg, DBP 90–100 mmHg; treat persistent BP ≥160/110 promptly with IV labetalol or equivalent).
Fluid and sodium restriction; avoid unnecessary IV fluids.
Strict input/output charting, daily weight, and close urine output monitoring.
Daily CBC, renal profile, electrolytes, LFT, and urine protein quantification (spot protein/creatinine or ACR).
Continue magnesium sulfate with monitoring for toxicity if renal function deteriorates or urine output falls.
No indication for dialysis or specific renal intervention at present.
Nephrology OPD follow-up after delivery for evaluation of bilateral polycystic kidneys and family screening.
Discussed with Dr. Raed.