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

Abstract

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.

Anti-phospholipase A2 Receptor Antibody-Negative Membranous Nephropathy in Pregnancy

“…Most of the data are obtained from case reports or case series regarding maternal-fetal outcomes in pregnant patients with nephrotic syndrome [2]. While some of these cases of pMN are diagnosed before pregnancy [3][4][5], there have been cases of pMN first diagnosed during pregnancy when patients presented with nephrotic syndrome [6][7][8]. Interestingly, only in very few case reports, the serum PLA2R antibody level was checked [6][7].…”

“…Both nephrotic syndrome and pregnancy are associated with hypercoagulability, so anticoagulation should be considered especially when there is profound hypoalbuminemia [12]. The choice of immunosuppression is very limited and includes steroids and calcineurin inhibitors (CNIs) [3][4][5] although rituximab has also been used [5].…”