Table 1.

Diagnostic criteria for preeclampsia: Diagnosis requires one essential and one additional clinical feature for diagnosis

Diagnostic CriteriaPreeclampsiaPreeclampsia in Women with CKD
Essential>20 wk gestation
New hypertension: systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg on two occasionsHypertension:
• In women without chronic hypertension: as for preeclampsia
• In women with chronic hypertension: no diagnostic threshold, de novo severe BP (systolic BP >160 mm Hg or diastolic BP >110 mm Hg) or an increase in treatment to maintain BP<160/110 mm Hg used in research cohorts (5,9)
AdditionalProteinuria:Proteinuria:
• UPCR≥0.3 mg/mg (>30 mg/mmol)• In women with nonproteinuric CKD: as for preeclampsia
• >300 mg/24 h (not indicated if UPCR available)• In women with proteinuric CKD: no diagnostic threshold,
• Dipstick >2+ (if other methods unavailable)>100% increase and UPCR≥0.3 mg/mg (>30 mg/mmol) used in research cohorts (5,9)
• UACR>70 mg/g (>8 mg/mmol) (54,75)
Serum creatinine:Serum creatinine:
• Serum creatinine >1.0a to 1.1 mg/dlb,c• In women with CKD and preserved excretory function: as for preeclampsia
• Doubling of serum creatinine <1.1 mg/dlb,c• In women with CKD and abnormal prepregnancy function: no consensus on diagnostic threshold for change in creatinine, >50% increase within 7 d used in research cohorts (5)
Hematologic complications:
• Platelets <100b–150a×109/Lc
• Hemolysisc, disseminated intravascular coagulationc
Liver complications:
• AST or ALT >40 IU/La or double normal reference limitb,c
• Epigastric/right upper quadrant pain (not attributable to alternate diagnosis)c
Neurologic complications:
• Eclampsiac
• Altered mental statusc
• Blindness, persistent visual scotomatac
• Strokec
• Clonus
• New-onset headache not attributable to alternate diagnosisc
Respiratory complications:
• Pulmonary edema not attributable to another diagnosisc
Uteroplacental dysfunction:
• Fetal growth restriction, abnormal umbilical artery Doppler waveform, stillbirth
  • UPCR, urinary protein-to-creatinine ratio; UACR, urinary albumin-to-creatinine ratio; AST, serum aspartate transferase; ALT, serum alanine transferase.

  • a Modified from reference 2, with permission.

  • b Modified from reference 3, with permission.

  • c Severe features.