Normal pregnancy: renal function: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Normal pregnancy: renal function

Sample item

A 26-year-old at 24 weeks with fever and flank pain has a serum creatinine of 1.0 mg/dL. Her pre-pregnancy value was 0.7 mg/dL. How should this value be interpreted?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Abnormally high for pregnancy, suggesting renal impairment

Glomerular filtration rate rises by about 50 percent in pregnancy, so serum creatinine falls to about 0.4 to 0.8 mg/dL. A value of 1.0 mg/dL, even though normal outside pregnancy, indicates reduced GFR and warrants evaluation, here likely for pyelonephritis. Pregnancy-specific reference ranges must be used.

Option by option

  • A. Uninterpretable, because creatinine is not affected by pregnancy

    Creatinine is clearly affected by the hyperfiltration of pregnancy.

  • B. Normal, because GFR falls by 50 percent in pregnancy

    GFR rises by about 50 percent, it does not fall.

  • C. Abnormally high for pregnancy, suggesting renal impairment (correct)

    Correct. Pregnancy hyperfiltration lowers creatinine, so 1.0 mg/dL signals significant renal impairment.

  • D. Normal, because creatinine rises in pregnancy

    Creatinine falls, not rises, because of increased GFR.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Abnormally high for pregnancy, suggesting renal impairment. Glomerular filtration rate rises by about 50 percent in pregnancy, so serum creatinine falls to about 0.

Why is "Uninterpretable, because creatinine is not affected by pregnancy" not the answer?

Creatinine is clearly affected by the hyperfiltration of pregnancy.

Why is "Normal, because GFR falls by 50 percent in pregnancy" not the answer?

GFR rises by about 50 percent, it does not fall.

Why is "Normal, because creatinine rises in pregnancy" not the answer?

Creatinine falls, not rises, because of increased GFR.

What concept does this question test?

It tests Normal pregnancy: renal function in OBG. 4 to 0.8 mg/dL. A value of 1.0 mg/dL, even though normal outside pregnancy, indicates reduced GFR and warrants evaluation, here likely for pyelonephritis. Pregnancy-specific reference ranges must be used.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Normal pregnancy: renal function?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.