Isolated Proteinuria of Pregnancy: A Call for Action

P regnancy is associated with physiological adaptations that facilitate meeting the increased metabolic demands and appropriate growth and development of the fetus. Various systems and organs are affected, including the kidneys and urinary system. Kidneys enlarge with progression of pregnancy (on average, by 1 cm) and this enlargement is accompanied by glomerulomegaly and dilation of the collecting system. The sum effect of volume expansion, increases in cardiac output and pulse rate, reduced systemic vascular resistance, and systolic and diastolic blood pressures is renal vasodilation and increased renal plasma flow (RPF) early in pregnancy. This is considered a major contributor to the hyperfiltration and increase in glomerular filtration rate (GFR) observed during pregnancy. This results in lower levels of serum creatinine levels, from a mean of 0.7 to 0.5 mg/dl, although pregnancyspecific creatinine values are not known. The hyperfiltration combined with the reduction of