Proteinuria: A presenting manifestation of mirror syndrome in pregnancy

Abstract

Hypertension and proteinuria in pregnant women are most commonly signs of preeclampsia which develops after 20 weeks of gestation. There are rare incidences of uncontrolled hypertension and nephrotic range proteinuria even in the first trimester of pregnancy which can be indicators of severe underlying fetal and placental abnormalities rather than preeclampsia. A G2P0 30-year-old Caucasian woman was admitted to University Hospital for the incidental finding of severe hypertension and proteinuria during her regular prenatal checkup at 14 weeks. She had complaints of mild bifrontal headache, facial and lower extremity edema. Her admission blood pressure was 193/108 mmHg, she had 8 g proteinuria, normal creatinine, and negative immunological and infectious workup. Further evaluation with dedicated obstetric ultrasonography showed hydropic placenta and fetus with aneuploidy. These findings strengthened the suspicion for a rare disease process called mirror syndrome, and emergent delivery was done to treat maternal disease process. Mirror syndrome is a rare disease that occurs basically due to fetal/placental pathology. It can present at any gestational period, and the clinical features include edema, proteinuria, and hypertension, mimicking preeclampsia. Prompt diagnosis and treatment is very crucial to prevent maternal complications. .

Mirror syndrome associated with fetal cardiomyopathy

“…On the other hand, mirror syndrome is associated with hemodilution and polyhydramnios opposed to hemoconcentration and oligohydramnios in PE and also younger gestational age at presentation (more than 50% of cases diagnosed between 26.5 and 27.5 weeks) [ 2 , 3 ]. The youngest patient noted in reports presenting with mirror syndrome was in her 14th week of pregnancy [ 7 ]. A systematic review of reports on mirror syndrome noted that key maternal signs were edema (80 to 100%), hypertension (57 to 78%), and proteinuria (20 to 56%), and the overall rate of fetal death was 56%.…”

A várandósság során jelentkező proteinuria differenciáldiagnosztikájának nehézségei

“…Vérnyomása romló tendenciát nem mutatott. A 28. várandóssági héten többszöri laboratóriumi kontroll során is jelentős proteinuria (15,(8)(9)(10)(11)(12)(13)(14)(15)(16)8 g/nap, szelektív glomerularis proteinuria, klinikai albuminuria), mérsékelten romló albuminszint (30-29 g/l) mutatkozott. A vizeletüledékben vörösvértest +, fehérvérsejt + mutatkozott, cylinder nem volt igazolható.…”

“…A várandósság alatt diagnosztizált kóros mértékű proteinuria etiológiájának tisztázásakor elsődleges a praeeclampsia kizárása [11], hiszen ez a terhesség során igazolt proteinuria leggyakoribb oka. Megkülönböztetünk átmeneti proteinuriát, melyet normális vesefunkció kísér, A proteinuria a hypertonia mellett a praeeclampsia egyik kardinális jele [12], mely a perinatalis anyai és magzati morbiditás, mortalitás vezető oka [13][14][15][16].…”