Glomerular Disease and Pregnancy. A Study of 123 Pregnancies in Patients with Primary and Secondary Glomerular Diseases

Surian, M; Imbasciati, E; Cosci, Pablo; Banfi, Giovanni; Belgiojoso, G. Barbiano di; Brancaccio, Diego; Minetti, L; Ponticelli, Claudio

doi:10.1097/00006254-198408000-00007

Cited by 15 publications

(31 citation statements)

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“…Therefore, it is necessary to differentiate between proteinuria caused by preeclampsia and primary glomerular disease when proteinuria continues beyond 4 weeks after delivery. Surian et al reported that the proportion of MN in patients with onset of nephropathy during pregnancy was approximately 10% (23). However, they did not distinguish between idiopathic and secondary MN.…”

Section: Discussionmentioning

confidence: 99%

Membranous Nephropathy with an Enhanced Granular Expression of Thrombospondin Type-1 Domain-containing 7A in a Pregnant Woman

et al. 2016

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A 30-year-old woman with proteinuria first noted at 26 weeks of gestation was admitted to undergo further evaluation. A renal biopsy revealed membranous nephropathy (MN). There was no evidence of any secondary MN. Prednisolone was initiated 6 months after delivery. Four months later, her urine protein became negative. Enhanced granular staining for thrombospondin type-1 domain-containing 7A (THSD7A) in the glomeruli was retrospectively detected in a biopsy specimen. A literature review revealed that 60% of cases of THSD7A-related MN occurred in women of childbearing age. Therefore, THSD7A-related MN should be considered in female patients presenting with idiopathic MN in childbearing age.

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Section: Discussionmentioning

confidence: 99%

Membranous Nephropathy with an Enhanced Granular Expression of Thrombospondin Type-1 Domain-containing 7A in a Pregnant Woman

et al. 2016

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“…In this context, several authors reported that there were cases in which focal segmental sclerosis and hyalinosis coexisted with preeclamptic nephropathy [4,5]. Most investigators regard such cases simply as primary or idio pathic focal and segmental glomerulosclerosis (FSGS) manifesting itself during preeclamptic pregnancy [6][7][8][9]. Recently, however, there appeared some papers suggest ing that FSGS lesion develops during pregnancy as a morphological expression of preeclamptic nephropathy [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Focal and Segmental Glomerulosclerosis in Preeclamptic Patients with Nephrotic Syndrome

Sasaki¹,

Dohi²,

Hanatani³

et al. 1990

Am J Nephrol

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Etiology and pathogenesis of focal and segmental glomerulosclerosis (FSGS) in patients with toxemia of pregnancy remain controversial. We examined 15 preeclamptic patients presenting with nephrotic syndrome. None of the patients had urinary abnormalities and hypertension before pregnancy. Clinically, proteinuria first developed during pregnancy and disappeared completely in all but one patient lost to follow-up after 1–30 months from delivery. Renal dysfunction, hypertension and edema rapidly resolved in the postpartum period. None of the patients had a progressive clinical course. Renal biopsy specimens obtained postpartum revealed typical features of preeclamptic nephropathy. In addition, findings compatible with FSGS were observed in 13 patients including 4 in which such lesions were unearthed by additional serial sectioning. These results indicate that FSGS may not only be induced by preeclampsia but also be one of the representative glomerular changes in preeclamptic patients with nephrotic syndrome. A favorable clinical course ensues in a manner similar to that of patients with the garden -variety of preeclampsia.

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“…One study reported both sclerosis and vascular disease to be associated with adverse events, but no others attempted to assess the relationship between histologic features and outcome (14). As expected, general themes that emerged included the association of adverse pregnancy outcomes, including perinatal death, preterm delivery, and small birth weight, with hypertension and renal insufficiency (3)(4)(5). In the second largest study of 118 pregnant women (9), women with hypertension at baseline (BP$140/90 mmHg) or impaired renal function (eGFR,70 ml/min per 1.73 m 2 ) were more likely to have an unsuccessful pregnancy.…”

Section: Systematic Review Of Primary Glomerular Diseasesmentioning

confidence: 84%

“…The most commonly reported GN was IgA nephropathy, with 12 studies including 10-136 patients (one study included two IgA cohorts) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The proportion of women with hypertension at baseline was reported in eight studies and ranged from 9% to 40%.…”

Section: Systematic Review Of Primary Glomerular Diseasesmentioning

confidence: 99%

“…Only four studies reported outcomes for women with FSGS (3,4,6,15), all were published before 1990, and all were small (17-31 pregnancies), with limited reporting of disease severity or hypertension. The proportion of live births ranged from 55% to 94% with high rates of complications (e.g., spontaneous abortion, 8%; preterm delivery, 24%; small for gestational age, 4%; perinatal death, 16% [3]), with hypertension, impaired renal function, and nephroticrange proteinuria identified to be associated with the greatest risk (3,4). Only two studies included women with minimal change disease (5,16) or membranous nephropathy (5,17), and similarly, nephrotic-range proteinuria and hypertension in the early stages of pregnancy were associated with worse pregnancy outcomes.…”

Section: Systematic Review Of Primary Glomerular Diseasesmentioning

confidence: 99%

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Pregnancy and Glomerular Disease

Blom

Odutayo

Bramham

et al. 2017

CJASN

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During pregnancy, CKD increases both maternal and fetal risk. Adverse maternal outcomes include progression of underlying renal dysfunction, worsening of urine protein, and hypertension, whereas adverse fetal outcomes include fetal loss, intrauterine growth restriction, and preterm delivery. As such, pregnancy in young women with CKD is anxiety provoking for both the patient and the clinician providing care, and because the heterogeneous group of glomerular diseases often affects young women, this is an area of heightened concern. In this invited review, we discuss pregnancy outcomes in young women with glomerular diseases. We have performed a systematic review in attempt to better understand these outcomes among young women with primary GN, we review the studies of pregnancy outcomes in lupus nephritis, and finally, we provide a potential construct for management. Although it is safe to say that the vast majority of young women with glomerular disease will have a live birth, the counseling that we can provide with respect to individualized risk remains imprecise in primary GN because the existing literature is extremely dated, and all management principles are extrapolated primarily from studies in lupus nephritis and diabetes. As such, the study of pregnancy outcomes and management strategies in these rare diseases requires a renewed interest and a dedicated collaborative effort.

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Glomerular Disease and Pregnancy. A Study of 123 Pregnancies in Patients with Primary and Secondary Glomerular Diseases

Cited by 15 publications

References 0 publications

Membranous Nephropathy with an Enhanced Granular Expression of Thrombospondin Type-1 Domain-containing 7A in a Pregnant Woman

Membranous Nephropathy with an Enhanced Granular Expression of Thrombospondin Type-1 Domain-containing 7A in a Pregnant Woman

Focal and Segmental Glomerulosclerosis in Preeclamptic Patients with Nephrotic Syndrome

Pregnancy and Glomerular Disease

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