Focal and Segmental Glomerulosclerosis in Preeclamptic Patients with Nephrotic Syndrome

Sasaki, Hideo; Dohi, Kazuhiro; Hanatani, Masakazu; Fujii, Yukihiko; Sanai, Hisao; Ichijo, Motohiko; Shimamoto, Ikuko; Ishikawa, Hajime; Watanabe, Teruo

doi:10.1159/000168082

Cited by 50 publications

(33 citation statements)

References 15 publications

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“…Renal biopsies were performed in 3 cases during pregnancy and in the present case after delivery. All biopsies revealed glomerular capillary endotheliosis, but did not show evidence for focal segmental glomerulosclerosis that can accompany the glomerular endotheliosis of preeclampsia [15]. In all cases, hypertension and proteinuria improved after medical termination or delivery.…”

Section: Discussionmentioning

confidence: 84%

Preeclampsia before 20 weeks of gestation: a case report and review of the literature

et al. 2014

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The occurrence of preeclampsia before 20 weeks of gestation is rare and usually associated with trophoblastic diseases or antiphospholipid syndrome. Here, we report a case of preeclampsia before 20 weeks of gestation in the absence of the aforementioned disorders. A healthy 30-year-old nulliparous woman presented with new onset of hypertension and proteinuria at 18 weeks of gestation. Fetal ultrasound did not reveal any abnormalities. Empirical steroid treatment was initiated based on a tentative diagnosis of underlying renal disease. The clinical course of the disease was progressive despite steroid treatment and the fetus died in utero 8 days after the initiation of treatment. Following delivery, a renal biopsy was performed and provided a diagnosis of preeclampsia. All symptoms resolved postpartum. This report demonstrates that preeclampsia may occur before 20 weeks of gestation and should always be considered in the differential diagnosis of pregnant women with new onset of hypertension with proteinuria. Previous published cases are summarized briefly.

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Section: Discussionmentioning

confidence: 84%

Preeclampsia before 20 weeks of gestation: a case report and review of the literature

et al. 2014

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“…In most cases, complete resolution has been reported to occur over a period of 3-6 mo, but full recovery has been found in some cases of preeclampsia to require in excess of 12 mo (14,22,30). Studies suggest that the preeclamptic glomerular injury can become chronic.…”

Section: Discussionmentioning

confidence: 99%

Course of preeclamptic glomerular injury after delivery

Hladunewich

Myers²,

Derby³

et al. 2008

American Journal of Physiology-Renal Physiology

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Hladunewich MA, Myers BD, Derby GC, Blouch KL, Druzin ML, Deen WM, Naimark DM, Lafayette RA. Course of preeclamptic glomerular injury after delivery. Am J Physiol Renal Physiol 294: F614-F620, 2008. First published January 16, 2008 doi:10.1152/ajprenal.00470.2007.-We evaluated the early postpartum recovery of glomerular function over 4 wk in 57 women with preeclampsia. We used physiological techniques to measure glomerular filtration rate (GFR), renal plasma flow, and oncotic pressure ( A) and computed a value for the two-kidney ultrafiltration coefficient (Kf). Compared with healthy, postpartum controls, GFR was depressed by 40% on postpartum day 1, but by only 19% and 8% in the second and fourth postpartum weeks, respectively. Hypofiltration was attributable solely to depression, at corresponding postpartum times, of Kf by 55%, 30%, and 18%, respectively. Improvement in glomerular filtration capacity was accompanied by recovery of hypertension to near-normal levels and significant improvement in albuminuria. We conclude that the functional manifestations of the glomerular endothelial injury of preeclampsia largely resolve within the first postpartum month. glomerular filtration rate; ultrafiltration coefficient; postpartum recovery AFFECTING 5-7% of pregnancies, preeclampsia remains a leading cause of maternal and fetal morbidity and mortality. Because the primary target of injury in preeclampsia is the glomerular endothelial cell, affected patients invariably present with depression of the glomerular filtration rate (GFR), proteinuria, and hypertension. We previously (13) evaluated glomerular morphology immediately after delivery. We demonstrated severe endothelial cell swelling with diminished size and density of the endothelial fenestrae, along with mesangial cell interposition and subendothelial fibrinoid deposits. These findings were computed to lower glomerular filtration capacity sufficiently to account for the observed depression of GFR by 40% (13).Despite the profound alterations in glomerular morphology, clinical recovery is usually rapid after delivery of the placenta. However, few detailed physiological evaluations of preeclampsia have been undertaken in the postpartum period. The characteristic glomerular pathological lesion has been reported to improve within days after delivery (21). Although complete recovery can occasionally require in excess of 6 mo, the majority of cases demonstrate complete resolution of the renal pathology within 3 mo (25). With the exception of those women with persistent postpartum hypertension, GFR and proteinuria also normalize over several months (18,(32)(33)(34).In the present study, we have employed precise physiological techniques to evaluate the postpartum course of the GFR and its determinants in women with preeclampsia. We combined our physiological findings with mathematical modeling to estimate glomerular ultrafiltration capacity. We observed a profound initial injury, which improved significantly after 4 wk. METHODSPatient population. This paper represents a...

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“…Механизмы не вполне ясны, од-нако поскольку характерным признаком ПЭ яв-ляется потеря подоцитов, предполагается зна-чимая роль гломерулярного повреждения [25]. Ассоциированный с ПЭ эндотелиоз, наблюдаемый, однако, и при нормальной беременности, может предвещать гломерулосклероз; одновременно мо-гут присутствовать также канальцевые и сосуди-стые повреждения [26,27].…”

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What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

et al. 2018

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Focal and Segmental Glomerulosclerosis in Preeclamptic Patients with Nephrotic Syndrome

Cited by 50 publications

References 15 publications

Preeclampsia before 20 weeks of gestation: a case report and review of the literature

Preeclampsia before 20 weeks of gestation: a case report and review of the literature

Course of preeclamptic glomerular injury after delivery

What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day

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