Hypertension and Proteinuria in early Pregnancy: Preeclampsia, Acute Intermittent Porphyria or Both?

AUTHORS

Biljana Gerasimovska Kitanovska 1 , * , Katica Zafirovska 2 , Stevka Bogdanovska 2 , Ljubinka Lozance 2

1 Department of Nephrology, University Clinics, Skopje Republic of Macedonia, bgerasimovska@yahoo.com

2 Department of Nephrology, University Clinics, Skopje Republic of Macedonia

How to Cite: Kitanovska B, Zafirovska K, Bogdanovska S, Lozance L. Hypertension and Proteinuria in early Pregnancy: Preeclampsia, Acute Intermittent Porphyria or Both?, Nephro-Urol Mon. Online ahead of Print ; 3(2):130-131.

ARTICLE INFORMATION

Nephro-Urology Monthly: 3 (2); 130-131
Article Type: Case Report
Received: August 27, 2010
Accepted: September 24, 2010

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Abstract

We report a case of early onset recurrent preeclampsia in a patient with positive family history of preeclampsia and a newly discovered acute intermittent porphyria. A 28 years old patient was admitted to our Clinic, due to early onset of preeclampsia in her third pregnancy. She had refractory hypertension with tachycardia, facial flush, anxiety and difficulty in breathing. During hospitalization, she reported occurrence of opalescent orange to reddish morning urine, which turned dark after a while. The dipstick test revealed positive urobilinogen in the urine. The same sample of urine was tested for porphobilinogens in the urine (by the use of Ehrlich's reagent) which were found positive and also porphyrins which were found negative; therefore, her medication was switched to a beta blocker. She decided to terminate pregnancy and this was done in the next few days by the use of anesthetics that are approved for acute intermittent porphyria. At her check up one month after delivery, her blood pressure was stabilized and the coproporphyrine, porphobilinogen and porphyrins from single void urine were all negative. In the check up 2 months after delivery, proteinuria of 0.5 g/day was still present; however, it reached to normal range (1g/day) after six months. To our knowledge, this is the first case reported in the literature where superimposed preeclampsia occurs in a patient with newly discovered acute intermittent porphyria.

Keywords

Acute intermittent porphyria Preeclampsia Hypertension

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