eGFR values and Pregnancy Induced Hypertension (PIH)

  1. Hi all- OB nurse here with some questions for you good folks...

    For ages, we've relied on 24-hour urine protein, creatine, & creatinine clearance values and serum uric acid levels to determine if a pt is headed down the slippery slope of PIH/preeclampsia and possible kidney failure. Uric acid is the main value our OB docs focus on as the most important indicator.

    We recently had an emergency c-section for a pt who came in with placental abruption (placenta separates from uterine wall=hemorrhage). She had been followed during the pregnancy for what had previously been mild PIH- labs were slightly off-kilter, but not terrible. Unfortunately, babe did not survive, and mom went to ICU with kidney failure and was later transferred out for dialysis.

    The nephrologist called in for consult prior to transfer told our OB docs that eGFR trends are a more reliable indicator in identifying the pt. at risk for PIH/ preeclampsia and poor maternal/fetal outcomes.

    All Things Renal was really never my forte, and the OB docs don't seem to have a real grasp of what eGFR actually IS, or at least, not enough to explain it to us. Honestly, all I can remember from A&P is that GFR stands for Glomerular Filtration Rate- that's it.

    Can anyone explain exactly what is the significance of eGFR values for the pregnant pt with PIH/preeclampsia, and why it is more reliable than serum uric acid? The nephrologist on consult must have been pretty convincing in order to change or OB group's focus away from serum uric acid values.

    Many thanks in advance!
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