Outcome of Pregnancy in Women with Glomerular Diseases

Abstract

Over the last 16 years the evolution of 24 pregnancies in 17 women with biopsy-proven glomerular disease was analyzed. The underlying renal histology was IgA nephropathy in 8 cases, lupus nephritis in 7, mesangiocapillary glomerulonephritis type I in 1, and focal segmental glomerulosclerosis in 1. All but 2 had normal renal function before conception and 3 were hypertensive. Fetal survival rate was 75%. There were 6 preterm deliveries (33.3%), 3 newborns small for gestational age (17%), 1 stillbirth, and 5 therapeutic abortions. The perinatal mortality was 5.5%. De novo hypertension occurred in 8 pregnancies (33.3%). In 11 pregnancies (46%) increased proteinuria was diagnosed and in 6 (25%) a decline in maternal renal function was recorded. Permanent impairment of renal function was seen in 2 women with renal insufficiency before conception. Maternal hypertension and renal function impairment were associated more frequently with obstetric complications. In conclusion, pregnancy is safe for normotensive mothers with glomerular diseases and normal renal function. Hypertension and impaired renal function at conception seem to carry increased risk for mothers and fetuses. Low-dose immunosuppressive treatment during pregnancy is not harmful for the fetus.

Nephrotic syndrome due to focal segmental glomerulosclerosis occurring in early pregnancy

“…Pregnancies associated with renal disease are high risk, and management is complex due to higher rates of maternal and fetal complications. 1 …”

Glomerulonephritis and the Nephrotic Syndrome in Pregnancy

“…83 Case series suggest that these outcomes are more dependent on hypertension or renal dysfunction at the time of conception, rather than the histological diagnosis. 63,71,84 Perinatal loss was found in 23% of 81 pregnancies and preterm delivery in 32% of 7 pregnancies reported by Imbasciati and Ponticelli. 66 Minimal change disease or FSGS should be confirmed by renal biopsy if nephrotic syndrome develops prior to 28 weeks.…”

“…66 Better outcomes are associated with preserved baseline renal function and normal blood pressure. 84,106,107 Pre-eclampsia, low birth weight and Caesarean section rates were higher in patients with biopsy-proven MCGN than those without. 108…”

“…The risk of pregnancy associated-worsening of maternal renal function in FSGS is associated with baseline renal dysfunction 71 and hypertension. 84 Progressive decline in renal function was reported in 5% of 84 pregnancies in patients with FSGS. 66 No relationship between degree of proteinuria and risk of pregnancy-associated loss of renal function has been established.…”

Hypertension in an Anthropological and Evolutionary Paradigm

“…16 ) Although the major focus of work related to cardiovascular events and pathology associated with hypertension has been in adults past reproductive age, there is abundant evidence across cultures and populations that high blood pressure is associated with both increased fetal and perinatal maternal morbidity and mortality rates. [17][18][19][20][21][22][23][24][25] This strongly indicates that hypertension reduces fitness. However, it should be recognized that a reduction in fitness does not absolutely follow, because a trait associated with increased fetal and perinatal maternal complications or death could also be associated with an increase in fecundity, which may overcompensate for reduced fetal or maternal survival rates.…”