15th July 2024

A 23-year-old female who is 15 weeks pregnant presents to A&E with shortness of breath on exertion

A 23-year-old female who is 15 weeks pregnant presents to A&E with shortness of breath on exertion. She is known to have progressive CKD secondary to lupus nephritis and is frequently seen in the advanced kidney care clinic. She is known to the obstetric-renal team. On examination, her blood pressure is 156/78. She has mild bilateral pitting oedema of her lower limbs. Her uPCR is 81 mg/mmol (unchanged since prior to pregnancy). Her urea is 18 mmol/L. Her creatinine is 403µmol/l (390µmol/l pre-conception). Her serum bicarbonate level is 24 mmol/L. Her current medication is Nifedipine 20 mg twice daily, Adcal 1 tablet three times daily with meals, alfacalcidol 250 mcg once daily and sodium bicarbonate 1g twice daily.

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