Kidney biopsy during pregnancy: a difficult decision. A case series reporting on 20 patients from Mexico

Kidney Biopsy in a Pregnant Patient with Suspected Glomerular Disease: PRO

“… 6 Finally, the case series of 20 patients in Mexico reported 1 of 20 (5%) experienced major bleeding and hematoma requiring blood transfusion; this biopsy was performed at 11 weeks' gestation. 5 Of note, in this series, most patients had kidney biopsies performed between 12 and 26 weeks' gestation, with only four patients biopsied after 26 weeks. In all cases described, biopsies were diagnostic with adequate tissue for analysis.…”

“…However, in a systematic narrative review of 11 studies including 197 antepartum biopsies and their complications from 1982 to 2012, minor complications such as macrohematuria and hematomas not requiring transfusion occurred in only 5% of cases. 5 Four major complications were reported (2%), all of which included major bleeding with perinephric hematomas requiring blood transfusion. Immediate fetal complications associated with biopsy were rare: One twin gestation developed placental abruption and preterm delivery, and one singleton gestation had preterm birth with perinatal death.…”

“…In all cases described, biopsies were diagnostic with adequate tissue for analysis. 5,6 Transplant patients were excluded from Piccoli's systematic review, and while reports of transplant kidney biopsy in pregnancy are few, it is believed to be better tolerated because of graft location. 9 In summary, while risks of complications of a kidney biopsy are higher in pregnancy than postpartum, they are similar to that of all patients who undergo a kidney biopsy.…”

“…4 In a recent case series of 20 pregnant patients who underwent kidney biopsy between 11 and 30 weeks for significant proteinuria, biopsy-confirmed diagnosis informed treatment: 17 of 20 patients received immunosuppression and had improvement in proteinuria, and three patients avoided immunosuppression because they were found to have unexpected advanced glomerulosclerosis or diabetic nephropathy. 5 A case series of biopsies performed in 11 pregnant patients with presumptive lupus flares identified proliferative lupus nephritis in 91% of patients, and the authors thoughtfully describe how five patients weighed this information with their values to determine whether to continue or terminate their pregnancy and how this affected their subsequent medical treatment as well. 6 A biopsy can also elucidate the etiology and determine treatment in kidney transplant patients with new-onset graft dysfunction and is recommended when necessary.…”

“…In all cases described, biopsies were diagnostic with adequate tissue for analysis. 5 , 6 Transplant patients were excluded from Piccoli's systematic review, and while reports of transplant kidney biopsy in pregnancy are few, it is believed to be better tolerated because of graft location. 9 …”