Increased antiangiogenetic factors in severe proteinuria without hypertension in pregnancy: is kidney biopsy necessary?

Abstract

Acute onset of severe proteinuria during pregnancy obliges physicians to clinically discriminate between gestational proteinuria (GP) and new onset of nephritis. A multiparous woman developed severe proteinuria (5.8 g/ day) without hypertension at 32 weeks of gestation. We measured the maternal level of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng), which were extremely high (41.3 and 54.8 ng/ml, respectively), leading us to consider this condition as GP rather than acute onset of nephritis. Thus, we did not perform a kidney biopsy and did not administer a steroid agent. Non-reassuring fetal status required emergency Cesarean section at 33 weeks. Proteinuria decreased to 0.36 g/day at 12 weeks after delivery, and finally disappeared 26 weeks postpartum. Measurement of sFlt-1 and sEng in a pregnant woman with severe proteinuria without hypertension may assist in differential diagnosis of GP from acute onset of nephritis, and thus help to decide whether to perform kidney biopsy during pregnancy.

Clinical usefulness of serum levels of soluble fms-like tyrosine kinase 1/placental growth factor ratio to rule out preeclampsia in women with new-onset lupus nephritis during pregnancy

“…In our previous case report, we described a parous woman who developed severe proteinuria (5.8 g/day at 32 weeks of gestation), although she did not show hypertension [17]. Because the sFlt-1 and sEng levels were very high, we decided not to perform a kidney biopsy, and not to prescribe a steroid-based agent [17]. After the cesarean section at 33 weeks, proteinuria decreased to 0.36 g/day in postpartum week 12, and finally disappeared in postpartum week 26, indicating that our presumptive diagnosis of gestational proteinuria in pregnancy was correct [17].…”

“…Measurement of the sFlt-1/PlGF ratio may be useful to discriminate gestational proteinuria without hypertension from new-onset glomerulonephritis only showing proteinuria in pregnancy. In our previous case report, we described a parous woman who developed severe proteinuria (5.8 g/day at 32 weeks of gestation), although she did not show hypertension [17]. Because the sFlt-1 and sEng levels were very high, we decided not to perform a kidney biopsy, and not to prescribe a steroid-based agent [17].…”

“…Because the sFlt-1 and sEng levels were very high, we decided not to perform a kidney biopsy, and not to prescribe a steroid-based agent [17]. After the cesarean section at 33 weeks, proteinuria decreased to 0.36 g/day in postpartum week 12, and finally disappeared in postpartum week 26, indicating that our presumptive diagnosis of gestational proteinuria in pregnancy was correct [17]. The circulating level of sFlt-1 is sometimes increased in women with gestational proteinuria, similar to those with preeclampsia [18].…”