eISSN: 2345-4202  
J Nephropharmacol. 2018;7(2):169-173.

Case Report

Preeclampsia without hypertension occurring at 17 weeks of amenorrhea; a case report and review of literature

Sindou Sanogo, Serge Didier Konan, Kouamé Hubert Yao * , Séry Patrick Diopoh, Jean Aka, Randolphe Niava

1 Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan, Côte d’Ivoire
*Corresponding author: Kouamé Hubert Yao; E-mail: Email: yaohubert@yahoo.fr

Abstract

In general, the term "preeclampsia" refers to the presence of hypertension associated with proteinuria occurring after 20 weeks of gestation in a previously non-proteinuric and normotensive woman. A 24-year-old woman, known to be non-hypertensive, carried two pregnancies and lost two babies. In 2011, as she was carrying the third (twin) pregnancy at 17 weeks of amenorrhea, she was admitted to the hospital for an 8-kilogram excess weight gain between two antenatal visits spaced 4 weeks apart. The clinical examination revealed 140 mmHg systolic blood pressure and 80 mm Hg diastolic blood pressure. The following days, the systolic blood pressure ranged between 110 and 120 mm Hg. Furthermore, the presence of bilateral and symmetrical pitting edema of the lower limbs was reported. The laboratory assessment upon admission showed the following results, proteinuria; 3.3 g/24 h, total albumin; 1.7 g/dL, total protein; 5.4 g/dL and total calcium was 75 g/L. The test results for HIV serology, HBs antigen and HCV antibodies as well as antinuclear and native anti-DNA antibodies were negative. The treatment consisted of iron, folic acid and calcium supplementation. Cesarean section was scheduled for the 38th week. The immediate aftermath was simple. Formula feeding was recommended for the newborns and ramipril 1.25 mg was initiated in the mother once daily. The evolution was marked by a progressive reduction in proteinuria around 500 mg/24 h six months after delivery, and below 200 mg/24 h one year later. Pre-eclampsia before 20 weeks of gestation is rare. Hypertension, which is its main clinical sign, may be exceptionally absent at this stage.

Implication for health policy/practice/research/medical education:

We report a case of pre-eclampsia revealed by a pure nephrotic syndrome without associated hypertension, on twin pregnancy discovered at the 17th week of gestation. Correction of hypocalcemia followed by cesarean section resulted in a favorable maternal and fetal evolution.

Please cite this paper as: Sanogo S, Konan SD, Yao KH, Diopoh SP, Aka J, Niava R. Preeclampsia without hypertension occurring at 17 weeks of amenorrhea; a case report and review of literature. J Nephropharmacol. 2018;7(2):169-173. 

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Submitted: 14 May 2018

Accepted: 17 Jun 2018
First published online: 26 Jul 2018
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