Postpartum Renal Failure in a Patient with Membranoproliferative Glomerulonephritis Type II

Leichter, Heinz E.; Jordan, Scott W.; Cohen, A H; Ettenger, Robert B.; Salusky, I B; Fine, R N

doi:10.1159/000167197

Cited by 7 publications

(4 citation statements)

References 7 publications

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“…All biopsies showed diffuse prolif erative glomerulonephritis (WHO class IV), with cellular crescents in 3. Previous reports suggest that pregnancy may occasionally be associated with reversible glomerular cres cents in women with underlying glomerulonephritis [32][33][34], However, this series demonstrates that cellular cres cents during pregnancy in lupus nephritis are a particularly ominous finding with all ofthese patients reachingend stage within 3 years of biopsy despite aggressive treatment.…”

Section: Discussioncontrasting

confidence: 54%

Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Krane¹,

Thakur²,

Wood³

et al. 1995

Am J Nephrol

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Patients with lupus nephritis frequently exhibit increasing proteinuria, hypertension and deterioration of renal function due to either active lupus nephritis, chronic lupus nephritis and/or superimposed preeclampsia during pregnancy. Percutaneous renal biopsies were therefore performed in 3 women with systemic lupus erythematosus during pregnancy and immediately postpartum in a fourth woman to evaluate their renal disease during pregnancy. Mean serum creatinine at renal biopsy was 2.9 mg/dl, with a mean creatinine clearance of 66 ml/min and protein excretion of 5.3 g/day. All patients had grade IV lupus nephritis and received pulse methylprednisolone immediately; 3 received cyclophosphamide. All 3 patients with crescent formation developed end-stage renal disease within 3 years. The fourth patient has normal renal function 3 years after biopsy. Percutaneous renal biopsies during pregnancy in women with lupus nephritis provide an accurate histopathologic diagnosis and are important in providing appropriate therapy, counseling and prognosis.

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Section: Discussioncontrasting

confidence: 54%

Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Krane¹,

Thakur²,

Wood³

et al. 1995

Am J Nephrol

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“…Packman et al 19 studied 395 pregnancies with primary glomerulonephritis, but failed to report a single instance of crescentic glomerulonephritis. A crescentic renal lesion has been found in some cases of preeclampsia in association with a number of other underlying kidney diseases, such as membranous glomerulonephritis, 20 membranoproliferative glomerulonephritis, 21 hereditary nephritis, 22 mesangial IgA nephropathy, 23 and even isolated preeclampsia itself. 9 In none of these cases was rapidly progressive glomerulonephritis on a clinical basis apparent, illustrating the nonspecific nature of the crescentic lesion.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Rapidly Progressive (Crescentic) Glomerulonephritis in Pregnancy

Dolkart¹,

Tapia²

1996

Amer J Perinatol

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Idiopathic rapidly progressive glomerulonephritis is an uncommon kidney disorder characterized by the rapid deterioration of renal function in association with glomerular crescent formation on renal biopsy. End-stage kidney failure is often the final outcome. There is only one complete case report of this condition during pregnancy. We describe a patient who initially presented with classic signs and symptoms of severe preeclampsia. She delivered a premature neonate that ultimately did well, but the mother subsequently demonstrated incremental deterioration in renal function. A kidney biopsy documented crescentic glomerulonephritis, and her clinical course was consistent with rapidly progressive glomerulonephritis.

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“…In women with previous MPGN, pregnancy appears to cause more obstetrical, fetal and renal complications than in other nephropathies [3]. Specifically, acute wors ening of renal function caused by superimposed rapidly progressive (crescentic) glomerulonephritis upon MPGN has been referred, with [4] or without [5] ultimate recovery.…”

Section: Discussionmentioning

confidence: 99%

Renal Thrombotic Microangiopathy in a Pregnant Patient with Membranoproliferative Glomerulonephritis

Aj¹,

Sobrado²,

Courel³

et al. 1988

Nephron

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Because glomerular diseases have an unforeseeable course during pregnancy, appropriate counseling is al ways compromised. Opposed evidence has been re ported without firm conclusions, and some risk factors are only considered as reference, e.g. serum creatinine (sCr) higher than 2 mg/dl, especially in the presence of severe hypertension.We report of a young female known to have membran oproliferative glomerulonephritis (MPGN) with stable renal function, controlled arterial pressure and moderate proteinuria, who developed a renal thrombotic microan giopathy in the later part of her second pregnancy. Case ReportA 24-year-old female, who had never taken oral contraceptives, presented at the age of 13 years with microscopic hematuria but no nephrotic proteinuria. She had normal renal function (sCr 0.6 mg/ dl) and blood pressure was 110/70 mm Hg. A percutaneous renal biopsy was performed 3 months later due to persistent urinalysis disorders. It contained 23 glomeruli, all of which were impaired, with lobulation of the tufts and marked mesangial hypercellulariiy. The capillary walls were thickened to a variable degree, and doublecontoured basement membranes were present. With Masson trich rome. deposits on the subendothelial side of the basement mem brane were observed. There were no sclerosis, crescents, nor intersti tial or vascular damage. An immunofluorescence technique was not performed. In short, it was a membranoproliferative glomerulo nephritis type 1, with subendothelial deposits.After treatment with steroids, her condition remained stable with 24-hour proteinuria 1.4 g. Seric C3 and C4 levels were normal and ANA and anti-ds-DNA antibodies negative. In 1982, she had her first pregnancy and the course as well as the delivery in February 1983 were normal without detrimental effects on nephropathy. Des pite an intrauterine device that was fitted in August 1983, she became pregnant in September. 2Vi months later, she developed high blood pressure (160/100 mm Hg) and proteinuria increased to 3 g/day without edema, but renal function was normal. Oral methyldopa I g/day was initiated. At 30 weeks of pregnancy, hematocrit was 36%, sCr 1.0 m g/dl and arterial pressure 160/105 mm Hg; hydralazine and propanolol were associated. 2 weeks later she was admitted to hospital for worsening of renal function (sCr 2.2 mg/dl), hematocrit (30%) and severe hypertension (170/120 mm Hg). The next week (33nd), sCr was 3.1 mg/dl, hematocrit 26%, and hyperten sion persisted with fundi examination grade III (K-W). A cesarean section was undertaken at this point and a premature, viable female infant of low weight (1,530 g) was born. A tubal ligature was also performed. In the postoperative course, diazoxide was prescribed and an increase of anemia (Hb 8.1 g/dl, hematocrit 23%) was observed. Signs of hemolytic activity were present: absent hapto globin level, reticulocyte count 109 x 109/l (40%o) and schistocytes 6-10%. White cell count (10 x I0V1), platelet count (138 x I0V1) and coagulation factors were normal, with plasma fibrin degrad...

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Postpartum Renal Failure in a Patient with Membranoproliferative Glomerulonephritis Type II

Cited by 7 publications

References 7 publications

Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Idiopathic Rapidly Progressive (Crescentic) Glomerulonephritis in Pregnancy

Renal Thrombotic Microangiopathy in a Pregnant Patient with Membranoproliferative Glomerulonephritis

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