Nephrotic syndrome due to focal segmental glomerulosclerosis occurring in early pregnancy

Smyth, Andrew; Wall, Catherine

doi:10.1258/om.2011.110010

Cited by 6 publications

(2 citation statements)

References 23 publications

(22 reference statements)

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“…Proteinuria often increases in gestation in patients with glomerular diseases; however, this increase was not observed in our patients ( Figure 1 , Figure 2 , Figure 6 , Figure 7 , Figure 9 and Figure 10 ). Interestingly, none of the patients developed a rapid reduction in renal function after delivery, which was different from many cases in the literature [ 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ].…”

Section: Discussioncontrasting

confidence: 79%

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

et al. 2017

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Chronic kidney disease (CKD) is increasingly recognized in pregnant patients. Three characteristics are associated with a risk of preterm delivery or small for gestational age babies; kidney function reduction, hypertension, and proteinuria. In pregnancy, the anti-proteinuric agents (ACE–angiotensin converting enzyme-inhibitors or ARBS -angiotensin receptor blockers) have to be discontinued for their potential teratogenicity, and there is no validated approach to control proteinuria. Furthermore, proteinuria usually increases as an effect of therapeutic changes and pregnancy-induced hyperfiltration. Based on a favourable effect of low-protein diets on proteinuria and advanced CKD, our group developed a moderately protein-restricted vegan-vegetarian diet tsupplemented with ketoacids and aminoacids for pregnant patients. This report describes the results obtained in three pregnant patients with normal renal function, nephrotic or sub-nephrotic proteinuria, and biopsy proven diagnosis of focal segmental glomerulosclerosis, a renal lesion in which hyperfiltration is considered of pivotal importance (case 1: GFR (glomerular filtration rate): 103 mL/min; proteinuria 2.1 g/day; albumin 3.2 g/dL; case 2: GFR 86 mL/min, proteinuria 3.03 g/day, albumin 3.4 g/dL; case 3: GFR 142 mL/min, proteinuria 6.3 g/day, albumin 3.23 g/dL). The moderately restricted diet allowed a stabilisation of proteinuria in two cases and a decrease in one. No significant changes in serum creatinine and serum albumin were observed. The three babies were born at term (38 weeks + 3 days, female, weight 3180 g-62th centile; 38 weeks + 2 days, female, weight 3300 g-75th centile; male, 38 weeks + 1 day; 2770 g-8th centile), thus reassuring us of the safety of the diet. In summary, based on these three cases studies and a review of the literature, we suggest that a moderately protein-restricted, supplemented, plant-based diet might contribute to controlling proteinuria in pregnant CKD women with focal segmental glomerulosclerosis. However further studies are warranted to confirm the potential value of such a treatment strategy.

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Section: Discussioncontrasting

confidence: 79%

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

et al. 2017

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“…She had no organ symptoms, such as cerebrovascular events, hepatic failure, or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) before or after 36 weeks. In addition, the presence of hematuria is not typical of preeclampsia [ 19 ]. Although the pathogenic role of many immunologic changes occurring during pregnancy remains unclear, we assume that pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of nephrotic syndrome due to pregnancy-related crescentic IgA nephropathy: a case report

Shima¹,

Doi²,

Okamoto³

et al. 2023

BMC Nephrol

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Background Crescentic immunoglobulin A (IgA) nephropathy, defined as > 50% of the glomeruli with crescents, often has a poor renal prognosis. Because of the high prevalence of pre-eclampsia in the second trimester of pregnancy, we often fail to investigate the new onset of glomerulonephritis and the aggravation of subclinical nephropathies. We report a case of nephrotic syndrome suggestive of crescentic IgA nephropathy possibly triggered by pregnancy. Case presentation A 33-year-old multipara was referred for persistent proteinuria, hematuria, and hypoalbuminemia two months postpartum. The patient was diagnosed with proteinuria for the first time at 36 weeks of gestation. The patient was normotensive during pregnancy. Renal biopsy revealed crescentic IgA nephropathy, with cellular crescents in 80% of the glomeruli and no global sclerosis. After treatment with pulse steroids followed by high-dose oral glucocorticoids and tonsillectomy, a gradual improvement was seen in proteinuria, hematuria, and hypoalbuminemia. Conclusion Although the precise mechanism remains unclear, pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy.

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Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

Fakhouri¹,

Schwotzer²,

Cabiddu³

et al. 2023

Kidney International

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Nephrotic syndrome due to focal segmental glomerulosclerosis occurring in early pregnancy

Cited by 6 publications

References 23 publications

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

Pregnancy, Proteinuria, Plant-Based Supplemented Diets and Focal Segmental Glomerulosclerosis: A Report on Three Cases and Critical Appraisal of the Literature

Successful treatment of nephrotic syndrome due to pregnancy-related crescentic IgA nephropathy: a case report

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management

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