Successful Management of Pregnancy with Nephrotic Syndrome due to Preexisting Membranous Glomerulonephritis: A Case Report

Sebestyén, András; Várbı́ró, Szabolcs; Sára, Levente; Deák, György; Kerkovits, Lóránt; Szabó, István; Kiss, István; Paulin, Ferenc

doi:10.1159/000151336

Cited by 22 publications

(9 citation statements)

References 14 publications

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“…The least toxic immunosuppressive agents used to treat various diseases in pregnancy are azathioprine and cyclosporine. There are several reported cases regarding the treatment of MN in pregnancy, mainly with corticosteroids, which all ended either with preterm delivery or with early elective termination of pregnancy [5,10,11,12]. Cyclosporine used in post-transplant maintenance therapy may be used to treat some forms of glomerulonephritis in pregnancy, including MN [13].…”

Section: Discussionmentioning

confidence: 99%

Various faces of the same disease: membranous nephropathy in pregnancy - A case series

Kezic¹,

Baralić²,

Tomasevic

et al. 2019

Srp Arh Celok Lek

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Introduction. Pregnancies in women with membranous nephropathy (MN) are usually complicated by increased proteinuria and superimposed preeclampsia, and this frequently results in poor pregnancy outcomes. The aim of this paper is to present case series of pregnant women with MN and different fetal and maternal outcomes. Outline of cases. Case 1 presents a 25-year-old woman with MN, who had relapsed nephrotic syndrome in early pregnancy with proteinuria of 4.14 g/day and serum albumin of 30 g/L accompanied by hypertension. Due to a missed abortion, the pregnancy was terminated. Three months later her proteinuria was still increased, measuring 3 g/day. Case 2 presents a 29-year-old woman with a history of diffuse proliferative glomerulonephritis, who conceived with proteinuria below 0.5 g/day. The proteinuria ranged between 1 and 2 g/day from the 32nd until the 38th gestational week, when she delivered a healthy neonate. After delivery, the woman underwent a kidney biopsy, which revealed MN. Case 3 presents a 25-year-old woman with MN, whose proteinuria was 1 g/day at the time of conception, but in the 35th gestational week proteinuria of 4.2 g/day was noticed. In the 36th gestational week, increased proteinuria was detected, and a cesarean section was performed with favorable neonatal outcome. After two weeks her proteinuria dropped to 0.6 g/day. Conclusion. Pregnancies in women with MN associated with low-grade proteinuria at the time of conception may have a favorable perinatal outcome. Such pregnancies require multidisciplinary management by both obstetricians and nephrologists, and team decision regarding the best timing of delivery.

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Section: Discussionmentioning

confidence: 99%

Various faces of the same disease: membranous nephropathy in pregnancy - A case series

Kezic¹,

Baralić²,

Tomasevic

et al. 2019

Srp Arh Celok Lek

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“…Although some studies have shown good neonatal outcomes in patients with nephrotic syndrome, others have demonstrated foetal loss rates ranging from 24% to 35%. Most of these losses were attributed to first trimester spontaneous miscarriages [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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

Farber

2018

OAJ Clin Case Rep

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There is little information about pregnancy outcomes in patients with active membranous nephropathy (MN), especially those with circulating autoantibodies to M-type phospholipase A2 receptor (PLA2R), the major autoantigen in primary MN. Membranous glomerulonephritis (MGN) represents an immunologically mediated disease characterized by deposition of immune complexes in the glomerular subepithelial space, frequently associated with circulating M-type phospholipase A2 receptor. Nephrotic syndrome (massive proteinuria and hypoalbuminemia) at diagnosis predicts poor prognosis. Pregnancy with active MGN is high risk for foetal loss, intrauterine growth restriction, and pre-eclampsia, and may worsen maternal renal function, especially with the presence of antiphospholipid antibody syndrome (APLA).We report a 23-year-old gravida in her first pregnancy, suffering from MGN and severe nephrotic syndrome, complicated by APLA syndrome. The patient was treated with enoxaparin, aspirin azathioprine, and Prednisone for a short time, in addition to furosemide and albumin intravenously. She was delivered at 30 weeks due to deteriorating maternal and foetal conditions.A successful neonatal and maternal outcome was achieved in this case. The patient's history revealed thrombocytopenia and APLA syndrome and continues to be treated chronically with enoxaparin. Kidney biopsy performed after delivery showed membranous MGN stage II-III. Herein, we present a case of successful pregnancy and foetal outcome in a young woman with APLA syndrome and MN.

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“…En caso de presentarse edema secundario a pérdida de proteínas como en el síndrome nefrótico durante el embarazo, se requeriría implementar un manejo más allá de la inmunosupresión. De forma conservadora el edema puede tratarse con elevación de miembros inferiores y compresión mecánica con medias de compresión, siendo necesario frecuentemente el uso de diuréticos de asa tipo furosemida o, en casos extremos, infusión de albúmina [1,43].…”

Section: La Valoración Preconcepcional Es La Piedra Angular Del éXito De La Gestación En Términos Generalesunclassified

Enfermedad renal crónica en la mujer embarazada

Calvo

Rico-Fontalvo²,

López

et al. 2020

Rev. Colomb. Nefrol.

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La enfermedad renal crónica (ERC), definida como una alteración estructural o funcional renal que persiste por más de 3 meses con o sin deterioro de la función renal o como un filtrado glomerular (FG) < 60 mL/min/1,73 m 2 sin otros signos de enfermedad renal, es una condición prevalente en la población general; sin embargo, no es tan frecuente en mujeres embarazadas. A pesar de su baja frecuencia en gestantes, el antecedente de enfermedad renal se asocia con peores desenlaces maternos y fetales cuando se presenta ERC. Las fórmulas estándar (CKD-EPI, Cockroft-Gault y MDRD) utilizadas para determinar la tasa de filtrado glomerular en población no obstétrica tienen poca precisión en las embarazadas debido a que subestiman la función renal en aproximadamente un 20 %. Ante esto, el aclaramiento de creatinina medido utilizando recolecciones de orina de 24 horas y la estimación de creatinina sérica que se correlaciona estrechamente con el aclaramiento de inulina (estándar de oro) son opciones que pueden utilizarse durante el embarazo. Asimismo, el reconocimiento temprano de la enfermedad, la optimización de las estrategias de nefroprotección, el evitar las drogas nefrotóxicas y la instauración de un tratamiento específico para la etiología garantizan una mayor sobrevida y un menor número de complicaciones derivadas de la enfermedad renal.

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Successful Management of Pregnancy with Nephrotic Syndrome due to Preexisting Membranous Glomerulonephritis: A Case Report

Cited by 22 publications

References 14 publications

Various faces of the same disease: membranous nephropathy in pregnancy - A case series

Various faces of the same disease: membranous nephropathy in pregnancy - A case series

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

Enfermedad renal crónica en la mujer embarazada

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