Pregnant Mom With 24 Hour Urine Question

I am confused about my current situation and need some more explanation.  I am 34 weeks pregnant, diagnosed with mild preeclampsia and in the hospital.  I have done 3 24-hour urine tests, with protein levels of 1000, 1700, then down to 1100.  My quick tests are usually trace to 1+.  My OB mentioned today that it is possible that this could be from a preexisting kidney problem?  Everytime I get a 24 hour test back a series of blood tests are run that show my kidneys are still functioning normally.  Before pregnancy I was having some very mild leg swelling and my family md ran a series of tests to check liver and kidney function, all were normal.  I also ruled out cardiac causes by having an EKG and ECHO with a cardiologist.  She felt the slight swelling was from being overweight.  I do not have diabetes or any other healthy problem.  I have had extensive work up in the past for GERD and had my pancreas and liver checks via ultrasound.  This is my 4th pregnancy and I never encountered preeclampsia or any other problems before.  The plan right now is to deliver my baby in two weeks.  My main concern now is what kind of preexisting kidney problem could I have had that was missed?  What should I do in the future after pregnancy?  I'm very concerned and anxious about doing any damage to my kidneys.  I am seen at a major teaching hospital, and they assure me although I'm spilling protein, I am not damaging my kidneys?  Please advise

[Kevin Pho, MD]

Blood tests looking at the kidney funtion is reasonable, and reported to be normal.  

I would consider some imaging studies - such as an ultrasound or IVP - to determine if there is a structural lesion leading to the protein.  

Other diseases like diabetes or congestive heart failure should be evaluated for.  A fasting sugar test can evaluate the former.  The latter disease is less likely with the normal echo.  

The most definitive test would be a kidney biopsy - however, this is normally considered if the protein is consistently above 2 grams.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[Christie2004]

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