One of the more challenging consultations in nephrology is evaluating a pregnant patient beyond 20 weeks’ gestation who presents with worsening proteinuria, high blood pressure, and increasing serum creatinine. In these situations, I am faced with deciding whether the findings show preeclampsia or the unmasking or progression of underlying chronic kidney disease (CKD). Preeclampsia often follows a more aggressive course and, in severe cases, may necessitate early delivery. In

Under normal circumstances, serum creatinine values are determined by its metabolic generation from the muscle, renal excretion, and, to...