At which frequency do you monitor proteinuria after delivery in women with preeclampsia and is there any evidence supporting the use of ACEI/ARB for treatment of such patients?
I recommed preeclamtic women to be monitored by their Primary Care Physician just performing an albumin/creatinine ratio in a spot urine sample between 4 and 8 weeks after delivery. The vast majority of cases become normoalbuminuric and no treatment is needed. Nevertheless, I use to recommend remote assessment, i.e. every 2 years, of cardiovascular risk stratification.
Thanks Manuel,
In fact my concern was about those who keep abnormal UAE 2 or 3 months after delivery. Would you go for more exploration (renal biopsy?) or you just continue a follow-up every 3-6 months?
Also about cardiovascular risk stratification, would you consider albuminuria as a risk factor that needs intervention ?
The resolution of pre-eclampsia-related proteinuria should occur by 12 weeks postpartum, if the proteinuria was, indeed, de novo and gestational. Once the woman's blood pressure has resolved (until which time I would see her at least weekly), then I would arrange a follow-up at around 12 weeks to ensure that proteinuria has settled if it outlasts the hypertension, using either a protein:creatinine or albumin:creatinine ratio.
In terms ACEI use during lactation, these are safe in breastfeeding.
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