Nephrotic syndrome in early pregnancy—is renal biopsy always necessary?

Pandya, Bhavna; Gibson, S. P.; Robertson, Ian

doi:10.1093/ndt/17.4.672

Cited by 15 publications

(12 citation statements)

References 12 publications

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“…Many issues concerning whether, and in what circumstances, kidney biopsy should be performed in pregnant women remain unresolved; these include indications for biopsy, for example sudden deterioration of kidney function before 32 weeks of gestation and differential diagnosis with pre‐eclampsia, and the effectiveness of empirical therapy, mainly with steroids . The rapid healing of pre‐eclamptic lesions led some authors to suggest postponing kidney biopsy until at least 2 months after delivery, whereas others have underlined the importance of early diagnosis and timely interventions in the presence of other glomerular diseases …”

Section: Introductionmentioning

confidence: 99%

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Piccoli¹,

Daidola²,

Attini³

et al. 2013

BJOG

173

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Background Kidney diseases, which have a prevalence of 3% in women of childbearing age, are increasingly encountered in pregnancy. Glomerulonephritis may develop or flare up in pregnancy, and a differential diagnosis with pre-eclampsia may be impossible on clinical grounds. Use of kidney biopsy is controversial, but a systematic review has not been carried out to date.Objectives To review the literature on kidney biopsy in pregnancy, with a focus on indications, risks and timing.Search strategy Medline, Embase, CHINAL and the Cochrane Library were searched in September 2012, with 'pregnancy' and 'kidney biopsy' used as MESH and free terms, for the period 1980-2012. Results were filtered for 'human' if this option was available.Selection criteria Biopsies during pregnancy and within 2 months after delivery. Case reports (fewer than five cases) and kidney grafts were excluded. Paper selection was performed in duplicate.Data collection and analysis Data were extracted in duplicate. The high heterogeneity in study design necessitated that the review be narrative, except for data on adverse events, which were analysed with regard to the timing of kidney biopsy.Main results Of 949 references, 39 were selected, providing data on 243 biopsies in pregnancy and 1236 after delivery (timing was unclear in 106 women). The main aims of the studies were to define morphology in pre-eclampsia (23 studies), to carry out a riskbenefit analysis of kidney biopsy (11 studies), and to investigate pregnancy-related acute kidney injury (five studies). Four cases of major bleeding complications occurred at 23-26 weeks of gestation. Relevant complications were observed in 7% of women during pregnancy and 1% after delivery (P = 0.001). Kidney biopsy performed for the diagnosis of glomerulonephritis or pre-eclampsia led to therapeutic changes in 66% of cases.Authors' conclusions The evidence on kidney biopsy in pregnancy is heterogeneous, but a significantly higher risk of complications (relative to postpartum biopsy) was found, with a possible peak at around 25 gestational weeks.

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Section: Introductionmentioning

confidence: 99%

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Piccoli¹,

Daidola²,

Attini³

et al. 2013

BJOG

173

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“…Performing kidney biopsies during pregnancy to differentiate pre-eclampsia from an underlying renal disease has been controversial. 9 Renal biopsies in pregnant patients have been reported since the 1950s. There are theoretical concerns that increased blood flow during pregnancy would increase biopsy complications.…”

Section: Discussionmentioning

confidence: 99%

Early pre-eclampsia unmasks underlying IgA nephropathy

Singh

Pappoe²,

Don³

2010

PLMI

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Pre-eclampsia is the most ominous complication of pregnancy, and primary glomerular diseases can mimic pre-eclampsia in presentation. A patient presented at 21 weeks gestation with signs and symptoms of both pre-eclampsia and primary glomerular nephropathy. A critical clinical decision whether to continue or terminate the pregnancy was dependent on results of a renal biopsy. The biopsy noted the presence of both pre-eclampsia and immunoglobulin A (IgA) nephropathy. Thus, the onset of pre-eclampsia unmasked the presence of unrecognized IgA nephropathy, and the IgA nephropathy was a risk factor for this patient developing pre-eclampsia. The results of a renal biopsy are key in distinguishing pre-eclampsia from other kidney diseases and instituting appropriate clinical management.

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“…Numerous case reports describe second trimester intrauterine death or termination of pregnancy with resolution of nephrotic syndrome post-partum. 35,38,[42][43][44] McLigeyo et al 45 reported 5 cases of nephrotic syndrome in early pregnancy with successful fetal outcomes, but two maternal deaths occurred within 5 years of delivery. In 13 women with nephrotic syndrome and known renal disease, 4 pregnancies ended in therapeutic termination, 1 with preterm delivery and 8 completed successfully at term.…”

Section: Nephrotic Syndromementioning

confidence: 99%

Glomerulonephritis and the Nephrotic Syndrome in Pregnancy

Hall

Brunskill

2010

Fet. Matern. Med. Rev.

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Glomerulonephritis (GN) may be manifest clinically in several ways. It may be asymptomatic and associated with only minor urinary dipstick abnormalities, GN may present with one of the classic renal nephritic or nephrotic syndromes, or may be associated with progressive chronic kidney disease with hypertension and the gradual development of uraemia, or it may present with fulminating life threatening illness with severe acute kidney injury. The development of GN may indicate a primary renal limited disease, or may be secondary in association with systemic diseases such as systemic lupus erythematosus (SLE), myeloma, infections or diabetes. Although immunological abnormalities underlie the development of many forms of GN, precise pathogenic mechanisms remain unclear and diagnostic labels may simply reflect a description of the glomerular histological changes observed (Table 1).

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Nephrotic syndrome in early pregnancy—is renal biopsy always necessary?

Cited by 15 publications

References 12 publications

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review

Early pre-eclampsia unmasks underlying IgA nephropathy

Glomerulonephritis and the Nephrotic Syndrome in Pregnancy

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