Kidney Biopsy in Pregnant Women with Glomerular Diseases: Focus on Lupus Nephritis

Abstract

Despite significant improvements of renal and obstetrical management, pregnancies in women with glomerular diseases and with lupus nephritis continue to be associated with increased complications both for the mother and the fetus as compared to those of pregnancies in healthy women. To reduce the risk of these complications, planning pregnancy in a phase of stable remission of the underlining disease is necessary. A kidney biopsy is an important event in any phase of pregnancy. A kidney biopsy can be of help during counselling before pregnancy in cases of incomplete remission of the renal manifestations. In these situations, histological data may differentiate active lesions that require the reinforcement of therapy from chronic irreversible lesions that may increase the risk of complications. In pregnant women, a kidney biopsy can identify new-onset systemic lupus erythematous (SLE) and necrotizing or primitive glomerular diseases and distinguish them from other, more common complications. Increasing proteinuria, hypertension, and the deterioration of kidney function during pregnancy may be either due to a reactivation of the underlying disease or to pre-eclampsia. The results of the kidney biopsy suggest the need to initiate an appropriate treatment, allowing the progression of the pregnancy and the fetal viability or the anticipation of delivery. Data from the literature suggest avoiding a kidney biopsy beyond 28 weeks of gestation to minimize the risks associated with the procedure vs. the risk of preterm delivery. In case of the persistence of renal manifestations after delivery in women with a diagnosis of pre-eclampsia, a renal kidney assessment allows the final diagnosis and guides the therapy.

Acute Kidney Injury Following Caesarean Section: A Case Report

“…Imaging tests, including renal ultrasound or CT, may also be necessary to diagnose cortical necrosis or obstructive uropathy [8]. Occasionally, a renal biopsy may be necessary to confirm the diagnosis and to help with prognosis if evidence of impairment persists [9].…”

Approach to Pregnancy in Patients With Lupus Nephritis

“…Biopsy is usually considered in pregnancy when progressive kidney function impairment and/or severe proteinuria could interfere with pregnancy outcomes and when establishing a diagnosis is needed to determine treatment. 6 The procedure should be considered possibly before 25 weeks of gestation age to reduce the risk of bleeding complications after biopsy, as alluded by Pontichelli et al 27 in a recent review on kidney biopsy in pregnant women with LN. 27 A systematic narrative review of nearly 200 kidney biopsies performed during pregnancy showed that the procedure is associated with a relatively small (2%) but increased risk of bleeding complication particularly around 25 weeks of gestation.…”