Membranous Nephropathy in Pregnancy

Abstract

Background: Primary membranous nephropathy (pMN) is less common in women of child-bearing age. The kidney risk factors to adverse maternal-fetal outcomes and the effects of pregnancy on pMN process need to be investigated. Methods: We retrospectively screened all the patients with biopsy-proven pMN from 2008 to 2018. Any cases of pregnancy that occurred at the time of pMN diagnosis or during follow-up were included in the study. Clinical and pathological data were collected from all patients at the time of kidney biopsy and their gestational results were recorded. Results: Of the 27 pregnancies with gestational time of 35.9 ± 4.5 weeks, 10 adverse maternal-fetal events occurred, including fetal loss (11%), preterm delivery (26%), and severe preeclampsia (15%). The kidney parameters were relatively stable with all preserved kidney function. Time-averaged urinary protein (p < 0.001) and serum albumin (p < 0.001), maximum urinary protein (p = 0.001) and minimum serum albumin (p = 0.01) before week 20, anti-phospholipase A2 receptor (PLA2R) positivity (p = 0.03), and no remission during pregnancy (p = 0.004) were risk factors to adverse maternal-fetal outcomes. Time-averaged urinary protein and serum albumin correlated with the birth weight percentile of neonates. Conclusions: Pregnancy in pMN patients showed risks to adverse maternal-fetal events. Heavy proteinuria, especially before week 20 of gestation, severe hypoalbuminemia, positive anti-PLA2R, and no remission were risk factors to worse outcomes.

Maternal and Fetal Outcomes of Pregnancy in Nephrotic Syndrome Due to Primary Glomerulonephritis

“…Trials investigating MN and pregnancy highlighted a reduced impact of this glomerulopathy on the incidence of abortion and stillbirths in the absence of risk factors, such as nephrotic range proteinuria during pregnancy (2,5,6,8,9,12,(14)(15)(16)(17)(18)(19)(20). A transient development of hypertension was registered in 7.7-45.4% of pregnancies, and increased proteinuria in up to 60% of cases confirmed an association of MN with worse fetal and maternal outcomes.…”

“…In particular, time-averaged proteinuria and serum albumin were associated with birth weight percentile of neonates. Moreover, anti-PLA2R antibody positivity (p = 0.03) appeared as a specific risk factor for pregnant MN patients (20). Interestingly, a case report of PLA2R positive MN patient undergoing pregnancy demonstrated the transplacental passage of these autoantibodies, which were detected in the fetus' cord blood (21).…”

“…The most recent retrospective study performed by Liu et al reported preserved kidney function but the occurrence of adverse materno-fetal complications including fetal loss (11%), preterm delivery (26%), and severe preeclampsia (15%) in 27 pregnancies from 2008 to 2018 in a cohort of women affected by MN (20). Consistent with De Castro' observations (19), Liu also demonstrated a correlation of proteinuria before week 20 (intended as both time-averaged urine protein, OR 67.5, p < 0.001; maximum proteinuria >3.5 g/day, OR 29.3, p = 0.001), hypoalbuminemia (time-averaged albumin, OR 67.5, p < 0.001; minimum serum albumin <25 g/L, OR 10.9, p = 0.01), and no-remission during pregnancy (OR 21.6, p = 0.004) with adverse materno-fetal outcomes.…”

Pregnancy and delivery in women receiving maintenance hemodialysis in Japan: analysis of potential risk factors for neonatal and maternal complications

“…Age at conception ≥ 38 years tended to have an increased association with maternal complications compared to ≤ 37 years, but neonatal complications developed in mothers whose ages were 32, 33 and 39 years. Furthermore, malnutrition suggested by sAlb ≤ 3.2 mg/dL in the first trimester appears to be a common risk for both maternal and neonatal complications [ 16 , 17 ]. These complex findings are in line with a previous report by Villar et al which proposed that preeclampsia (as a maternal complication) and FGR (as a neonatal complication) may have distinct etiologies among obstetric disorders [ 18 ].…”

Recent Advances in Clinical Diagnosis and Pharmacotherapy Options of Membranous Nephropathy

“…Membranous nephropathy (MN) is one of the most common causes of formation of nephrotic syndrome in adults, accounting for 30% incidence of patients (1.7/100000/year), with a 67% male preponderance and a high incidence in humans aged 30–50 years ( Bally et al, 2016 ). It is unwonted in children ( Liu et al, 2020a ; Tamura, 2021 ). MN mainly affects renal glomerulus, particularly podocytes in glomerulus, indicating that podocytes play a critical role in regulating renal permeability to various molecules including proteins ( Ronco and Debiec, 2020 ).…”