Board question of the week: Hypertension-1

A 26-year-old primigravid woman is admitted during her 34th week of pregnancy with severe, refractory hypertension. She was noted to have mild hypertension prior to pregnancy. Her family history is remarkable for pregnancy-related hypertension in her aunt. Her blood pressure decreased early in the course of the pregnancy, but then rose dramatically, reaching 170/100 mmHg at 29 weeks despite antihypertensive therapy. She denies any edema or neurologic changes.

Her chemistries are listed below:

Na-143 K-3.6 Cl-110 HCO3-28 BUN-8 Creat-0.5 Uric Acid-3

Urinalysis negative for blood and protein

Urine electrolytes:

Urine sodium 20 meq/L, Urine potassium 75meq/L

Renin and Aldosterone level were both suppressed

Due to worsening blood pressure, a Caesarian section was performed, and the patient delivered a healthy baby girl. Her blood pressure control stabilized shortly after delivery.

The answer and explanation will be posted on Monday July 7th

Michael Lattanzio DO

*RFN board questions are meant to help introduce concepts about nephrology related diseases and do not represent actual questions seen on the ABIM exam.