Pregnancy Outcomes in Patients with Glomerular Disease Attending a Single Academic Center in North Carolina

Abstract

Background: Contemporary data regarding pregnancy outcomes in US patients with primary glomerular diseases are lacking. We aimed to report fetal and maternal outcomes among women with biopsy-proven primary glomerular disease who received obstetric care at a single large academic US center. Methods: All women with a biopsy-confirmed primary glomerular disease diagnosis and without end-stage kidney disease who received obstetric care at the University of North Carolina (UNC) Hospitals (1996-2015) were identified using the Glomerular Disease Collaborative Network registry and the UNC Hospitals Perinatal Database. The primary study outcome was perinatal death (stillbirth at >20 weeks or neonatal death). Secondary outcomes included premature birth (<37 weeks), birth weight, preeclampsia, and kidney function changes (postpartum vs. baseline). Demographics, clinical characteristics, and outcomes were compared across glomerular disease subtypes. Results: Among 48 pregnancies in 43 women (IgA nephropathy n = 17, focal segmental glomerulosclerosis [FSGS] n = 16, membranous nephropathy n = 6, minimal change disease n = 4), 13% of pregnancies resulted in perinatal death and 48% of babies were born prematurely. From a maternal perspective, 33% of pregnancies were complicated by preeclampsia, 39% by a doubling of urinary protein, and 27% by a ≥50% increase in serum creatinine. Outcome differences across glomerular disease subtypes were not statistically significant, although decline in kidney function appeared most frequent in FSGS. Conclusion: Adverse pregnancy outcomes are frequently observed in women with glomerular disease. The independent influence of glomerular disease subtype on outcomes requires further study. More widespread reporting and analysis of pregnancy outcomes in women with glomerular disease are urgently needed.

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

“…[1][2][3][4][5][6][7][8][9][10] Conversely, pregnancy in patients with already diagnosed FSGS is known to have a higher risk for complications, including preeclampsia, preterm delivery, and increases in proteinuria. [11][12][13][14][15][16] Hyperfiltration stress, which is likely to increase in pregnancy, has been identified as a potential, albeit not confirmed, risk factor for the development of an overt clinical picture of FSGS. This can be an issue in women born with very low birth weight, a population known to have a reduced nephron number and to be particularly prone to developing FSGS.…”

Successful foetal outcome in a patient with primary membranous nephropathy and circulating anti-phospholipid antibodies: A case report

“…However, it can be secondary to a wide spectrum of aetiologies, for instance infections, tumours, autoimmune diseases, or exposure to drugs or toxic agents. The presence of persistent proteinuria during the pregnancy predicts poor foetal and maternal outcomes [4][5][6]. Nephrotic proteinuria presenting in the first half of pregnancy is suggestive of a primary kidney disease, rather than pre-eclampsia [1].…”

“…In women with chronic kidney disease, proteinuria >1 g/day is associated with increased risk of adverse pregnancy and neonatal outcomes, including preterm delivery, small for gestational age infants, and need for neonatal intensive care observation. Specifically, in addition to the risk described for proteinuria complicating pregnancies, pregnancy with MGN is associated with increased foetal loss and, in some instances, a progressive loss of maternal renal function [3][4][5][6].…”

Pregnancy in immunoglobulin M nephropathy

“…A meta‐analysis of eight cohort studies of 1268 patients with chronic kidney disease and well‐preserved kidney function at baseline demonstrated a high rate of pregnancy complications, including pre‐eclampsia, preterm delivery and growth‐restricted babies . Previous studies have also suggested that maternal outcomes such as pre‐eclampsia, decline in kidney function and the need for dialysis and fetal outcomes, such as fetal loss, perinatal loss and prematurity, might differ according to glomerular disease subtype, being poorer in women with FSGS than MCD . IgM nephropathy, MCD and FSGS may present similar clinical manifestations during pregnancy, such as nephrotic syndrome, hematuria and/or asymptomatic proteinuria.…”

“…15 Previous studies have also suggested that maternal outcomes such as pre-eclampsia, decline in kidney function and the need for dialysis and fetal outcomes, such as fetal loss, perinatal loss and prematurity, might differ according to glomerular disease subtype, being poorer in women with FSGS than MCD. 16,17 IgM nephropathy, MCD and FSGS may present similar clinical manifestations during pregnancy, such as nephrotic syndrome, hematuria and/or asymptomatic proteinuria. However, they are distinguished during the clinical course in response to therapy and the mode of progression to ESRD.…”