The role of renal biopsy in women with kidney disease identified in pregnancy

Day, Clara; Hewins, Peter; Hildebrand, Sarah; Sheikh, Lumaan; Taylor, Gabrielle; Kilby, Mark; Lipkin, Graham

doi:10.1093/ndt/gfm572

Cited by 63 publications

(40 citation statements)

References 19 publications

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“…The risks and benefits of biopsy versus delivery should be considered with the obstetrical and neonatal providers. Although early studies reported high complication rates, including gross hematuria in 16.7% and perirenal hematoma in 4.4% (61), more recent series report similar complication rates to nonpregnant women (62,63).…”

Section: Antepartum Managementmentioning

confidence: 96%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or preeclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancyrelated complications. This review discusses the pathogenesis, maternal and fetal risks, and management pertinent to SLE patients with new onset or a history of LN predating pregnancy.

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Section: Antepartum Managementmentioning

confidence: 96%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Day et al [20] showed that pregnancy itself does not increase the risk associated with a renal biopsy. In contrast to that, other investigators reported a significantly higher risk of complications for kidney biopsies in pregnancy, with a peak at around the 25 th gestational week [21] .…”

Section: Proteinuria In Pregnancymentioning

confidence: 99%

Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy

Müller-Deile

Schiffer

2014

WJN

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Proteinuria is a frequently detected symptom, found in 20% of pregnancies. A common reason for proteinuria in pregnancy is preeclampsia. To diagnose preeclampsia clinically and to get new insights into the pathophysiology of the disease it is at first essential to be familiar with conditions in normal pregnancy. Animal models and biomarkers can help to learn more about disease conditions and to find new treatment strategies. In this article we review the changes in kidney function during normal pregnancy and the differential diagnosis of proteinuria in pregnancy. We summarize different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. We describe the current animal models and give a broad overview of different biomarkers that were reported to predict preeclampsia or have a prognostic value in preeclampsia cases. We end with a summary of treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia. Most of these novel biomarkers for preeclampsia are not yet implemented in clinical use. Therefore, we recommend using proteinuria (measured by UPC ratio) as a screening parameter for preeclampsia. Delivery is the only curative treatment for preeclampsia. In early preeclampsia the primary therapy goal is to prolong pregnancy until a state were the child has an acceptable chance of survival after delivery.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Preeclampsia; Pregnancy; Proteinuria; Biomarkers; Treatment Core tip: This review summarises different pathophysiological theories of preeclampsia with a special focus on the renal facets of the disease. In this context current animal models are presented. The reader gets a broad overview about different biomarkers for preeclampsia. Furthermore, the article discusses treatment options for preeclampsia related symptoms including the use of plasmapheresis as a rescue therapy for so far refractory preeclampsia.Müller-Deile J, Schiffer M. Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy. World

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“…Publicaciones posteriores muestran una disminución franca de las complicaciones. En la última década queremos destacar dos por su mayor casuística: una revisión retrospectiva (1990-1999), publicada por Chen et al (n = 15, mediana de edad 28 años), y otra 14,3 . Llama la atención el número de casos comunicados que no supera los 15 por década.…”

Section: Discussionunclassified

“…La otra desarrolló una falla renal aguda de causa incierta. Ambas reunían las condiciones que se estiman necesarias para una adecuada relación riesgo/beneficio de la biopsia renal 3 .…”

Section: Discussionunclassified

“…Existen diferentes opiniones sobre la necesidad de una biopsia renal durante la gestación. Los hallazgos histológicos reportados incluyen nefritis lúpica, nefropatía de cambios mínimos, glomeruloesclerosis focal y segmentaria (GEFS), glomerulonefritis mesangioproliferativa y nefropatía por IgA 3 . Se han reportado casos de SN asociado a tumor trofoblás-tico con diversas lesiones glomerulares incluyendo la glomerulopatía membranosa, y se ha sugerido, que las anormalidades fetales o placentarias deben ser excluidas antes de plantear la biopsia 2,4,5 .…”

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Biopsia renal en el segundo trimestre del embarazo: Dos casos clínicos

et al. 2013

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Renal biopsies during the second trimester of pregnancy. Report of two cases L as glomerulopatías primarias que se inician en el embarazo son muy infrecuentes. Aquellas que cursan con síndrome nefrótico (SN) tienen una incidencia de 0,12 a 0,25 x 1.000 1,2 . Existen diferentes opiniones sobre la necesidad de una biopsia renal durante la gestación. Los hallazgos histológicos reportados incluyen nefritis lúpica, nefropatía de cambios mínimos, glomeruloesclerosis focal y segmentaria (GEFS), glomerulonefritis mesangioproliferativa y nefropatía por IgA 3 . Se han reportado casos de SN asociado a tumor trofoblás-tico con diversas lesiones glomerulares incluyendo la glomerulopatía membranosa, y se ha sugerido, que las anormalidades fetales o placentarias deben ser excluidas antes de plantear la biopsia 2,4,5 . Comunicamos un caso de SN y otro de falla renal progresiva durante el segundo trimestre del embarazo en los que se decidió realizar una biopsia renal. Paciente Nº 1Primigesta de 21 años, sin antecedentes. Cursando un embarazo de 21 semanas, desarrolló en forma brusca edema generalizado sin hipertensión arterial (HTA). Fue hospitalizada y se comprobó un SN con proteinuria de 14 g/día, sin deterioro funcional renal (creatininemia 0,6 mg/dL). El hemograma, la glicemia y el test de tolerancia a la glucosa oral resultaron normales. Colesterol total 387 mg/dL. El sedimento urinario mostró 15-20 glóbulos rojos por campo. Los anticuerpos antinucleares (ANA), contra el citoplasma de neutrófilos (ANCA), anti ADN, anticardiolipinas, anticoagulante lúpico; complemento C3 y C4, VDRL, serología para VIH, hepatitis B y C resultaron todos negativos. Ecotomografía: riñones de aspecto y tamaño normal. Inició reposo, restricción de sal y furosemida. Mantuvo proteinuria masiva sin fundir edemas. Frente a la gravedad del cuadro (albuminemia 1,2 g/dL; proteinemia 3,2 g/dL), los riesgos potenciales de una terapia esteroidal empírica y los casi cinco meses restantes para el término del embarazo, se decidió practicar, previo consentimiento informado, una biopsia renal. Paciente Nº 2Multípara de 34 años con antecedentes de enfermedad de Crohn inactiva. Cursando un embarazo de 24 semanas consultó por dolor epigástrico.

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The role of renal biopsy in women with kidney disease identified in pregnancy

Cited by 63 publications

References 19 publications

Obstetric Nephrology

Obstetric Nephrology

Preeclampsia from a renal point of view: Insides into disease models, biomarkers and therapy

Biopsia renal en el segundo trimestre del embarazo: Dos casos clínicos

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