List 6 clinical features of preeclampsia.
Preeclampsia usually begins in the third trimester, but can occur earlier in patients with preexisting renal disease or hypertension. It can also occur postpartum with hypertension and seizures 24-48 hours after delivery. It usually resolves 10 days after delivery.
It presents with weight gain and edema, particularly of the hands and face, with variable increases in blood pressure and proteinuria.
There is a fall in renal blood flow and GFR that can lead to hyperuricemia and hypocalciuria as well as acute renal failure. The acute renal failure is thought to be due to glomerular endotheliosis with swelling of endothelial cells and subendothelial hyaline and fibrin deposition. Acute tubular necrosis and cortical necrosis can also occur.
Pulmonary edema can occur due to changes in pulmonary capillary permeability. Hyperreflexia reflects increased nervous system excitability.When preeclampsia is more severe, it can progress to the HELLP syndrome with hemolysis, elevated liver enzymes, and low platelets.
Due to decreased placental perfusion, fetal growth restriction and oligohydramnios can occur.
Pregnancy: kidney diseases and hypertension. Am J Kidney Dis. 2007 Feb;49(2):336-45.