A 28-year-old woman, gravida 1 para 0, at 16 weeks gestation comes to the office for a prenatal visit. The patient feels well and has no concerns. Medical history is significant for recurrent urinary tract infections. Her only medication is a prenatal multivitamin. Blood pressure is 116/68 mm Hg and pulse is 80/min. Physical examination shows no abnormalities and fetal heart tones are normal. Urine dipstick reveals no blood or leukocyte esterase but is positive for protein. Laboratory testing shows the following: A 24-hour urinary protein excretion is 200 mg. Which of the following processes is most likely contributing to this patient's urinary findings?

Question

A 28-year-old woman, gravida 1 para 0, at 16 weeks gestation comes to the office for a prenatal visit.  The patient feels well and has no concerns.  Medical history is significant for recurrent urinary tract infections.  Her only medication is a prenatal multivitamin.  Blood pressure is 116/68 mm Hg and pulse is 80/min.  Physical examination shows no abnormalities and fetal heart tones are normal.  Urine dipstick reveals no blood or leukocyte esterase but is positive for protein.  Laboratory testing shows the following:  A 24-hour urinary protein excretion is 200 mg.  Which of the following processes is most likely contributing to this patient's urinary findings?

Quizplus · Accepted Answer

Eductional Objective: Physiologic renal adaptations during pregnancy include increased glomerular filtration rate, greater basement membrane permeability, and decreased tubular resorption of filtered protein.  As a result, trace urinary protein excretion (ie, <300 mg/24 hr) is a normal finding in pregnancy.

A 28-Year-Old Woman, Gravida 1 Para 0, at 16 Weeks