A 21-Year-Old Pregnant Woman with Hypertension and Proteinuria 英文参考文献.docVIP

Learning Forum A 21-Year-Old Pregnant Woman with Hypertension and Proteinuria Andrea Luk, Ronald C. W. Ma*, Ching Wan Lam, Wing Hung Tam, Anthony W. I. Lo, Enders K. W. Ng, Alice P. S. Kong, Wing Yee So, Chun Chung Chow D E S C R I P T I O N o f C A S E Box 1: Causes of Hypertension in Pregnancy sè 0RE ECLAMPSIA A 21-year-old pregnant woman, gravida 2 para 1, presented with hypertension and proteinuria at 20 weeks of gestation. She had a history of pre-eclampsia sè %SSENTIALèHYPERTENSION sè 2ENALèARTERYèSTENOSIS in her first pregnancy one year ago. During that pregnancy, at 39 weeks of gestation, she developed high blood pressure, proteinuria, and deranged liver function. She eventually delivered by emergency caesarean section following failed induction of labour. Blood pressure returned to normal post-partum and she received no further medical follow-up. Family history was remarkable for her mother’s diagnosis of hypertension in her fourth decade. Her father and five siblings, including a twin sister, were healthy. She did not smoke nor drink any alcohol. She was not taking any regular medications, health products, or herbs. sè LOMERULOPATHYè sè 2ENALèPARENCHYMAèDISEASE sè 0RIMARYèHYPERALDOSTERONISMè#ONN SèADENOMAèORèBILATERALè adrenal hyperplasia) sè #USHING SèSYNDROME sè 0HAEOCHROMOCYTOMA sè #OARCTATIONèOFèAORTA sè /BSTRUCTIVEèSLEEPèAPNOEA At 20 weeks of gestation, blood pressure was found to be elevated at 145/100 mmHg during a routine antenatal clinic visit. Aside from a mild headache, she reported no other symptoms. On physical examination, she was tachycardic with heart rate 100 beats per minute. Body mass index was 16.9 remembered that this could also reflect underlying renal damage due to chronic untreated hypertension. Additionally, her electrocardiogram showed left ventricular hypertrophy, which was another indicator of chronicity. While pre-eclampsia might still be a potential cause of hypertension in our case, the possibility of pre-existing hypert