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 for bilateral renal cysts noted on ultrasound. The patient denies decreased urine output, dysuria, hematuria, flank pain, frothy urine, fever, chills, nausea, vomiting, or previous history of kidney disease. No history of nephrolithiasis or dialysis. Family history could not be obtained due to language barrier.

O/E:
Conscious, alert, oriented.
BP 159/101 mmHg (received labetalol 100 mg PO and IV labetalol 20 mg + 40 mg).
Chest clear, no respiratory distress.
CVS: S1S2 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 within normal limits.

Imaging:
US abdomen: Bilateral pleural effusions, mild ascites, bilateral kidneys of normal size with mild increased cortical echogenicity (Grade I nephropathy), normal renal vascularity, and multiple bilateral cortical renal cysts (largest 3.5 cm on the right and 3.4 cm on the left). No hydronephrosis or obstructive uropathy.

Assessment:

• Severe preeclampsia with uncontrolled hypertension.

• Third-spacing with bilateral pleural effusions and mild ascites, likely secondary to severe preeclampsia with hypoalbuminemia.

• Multiple bilateral renal cortical cysts with preserved renal function; findings are not diagnostic of ADPKD and require outpatient evaluation after pregnancy.

• No AKI and no indication for renal replacement therapy.

Plan:

• Continue BP control as per Obstetrics severe hypertension protocol (target SBP 140–150 mmHg and DBP 90–100 mmHg; treat persistent BP ≥160/110 mmHg promptly).

• Continue magnesium sulfate as per Obstetrics protocol.

• Salt and fluid restriction with strict input/output charting and daily weight.

• Monitor daily CBC, renal profile, electrolytes, LFT, urine protein quantification, and urine output.

• Avoid nephrotoxic medications and NSAIDs.

• No indication for dialysis or other nephrology intervention at present.

• Nephrology OPD follow-up after delivery for further evaluation of bilateral renal cysts.

• Discussed with Dr. Raed.