Pregnancy Is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis in Women with a History of Very Low Birth Weight

Tanaka, Mari; Iwanari, Sachio; Tsujimoto, Yasushi; Taniguchi, Keisuke; Hagihara, Koichiro; Fumihara, Daiki; Miki, Syo; Shimoda, Saeko; Ikeda, Masaki; Takeoka, Hiroya

doi:10.2169/internalmedicine.56.8032

Cited by 5 publications

(6 citation statements)

References 14 publications

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“…Individuals born small reportedly have fewer glomeruli [49,50]. Furthermore, increased renal plasma flow during pregnancy results in nearly a 50% increase in glomerular filtration [48], which might trigger glomerular damage, leading to pregnancy complications [49,50]. Our findings were consistent with previous studies that assessed the association between size at birth and prematurity and other pregnancy outcomes, such as gestational diabetes and infant LBW [35,51,52].…”

Section: Figuresupporting

confidence: 89%

Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis

Tsujimoto

Kataoka²,

Banno³

et al. 2021

Journal of Hypertension

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Background: Growing evidence suggests that women born preterm or small have an increased risk of experiencing hypertensive disorders during pregnancy; however, a quantitative summary of the evidence on this issue is unavailable.Objective: We aimed to systematically review the literature to describe the association between being born preterm, low birthweight (LBW), or small for gestational age (SGA), and future gestational hypertension, preeclampsia, or eclampsia. Methods:We searched the MEDLINE, Embase, CINAHL, ClinicalTrials.gov, and ICTRP databases. We included all cohort and case-control studies examining the association between LBW, preterm birth, or SGA and hypertensive disorders in pregnancy. We pooled the odds ratios and 95% confidence intervals using the DerSimonian and Laird random-effects model. We assessed the certainty of evidence for each outcome using the Grading of Recommendations, Assessment, Development, and Evaluation criteria.Results: Eleven studies were identified, totalling 752 316 participants. Being born preterm, LBW, or SGA was associated with gestational hypertension [pooled odds ratio (OR), 1.31; 95% confidence interval (CI) 1.15-1.50; moderate certainty of evidence] and preeclampsia (pooled OR, 1.35;; moderate certainty of evidence). No study measured eclampsia as an outcome. Conclusion:Women born preterm, LBW, or SGA have an increased risk of gestational hypertension and preeclampsia. The course of the mother's own birth might be used to identify women at risk of gestational hypertension and preeclampsia.

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Section: Figuresupporting

confidence: 89%

Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis

Tsujimoto

Kataoka²,

Banno³

et al. 2021

Journal of Hypertension

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“…This can be an issue in women born with very low birth weight, a population known to have a reduced nephron number and to be particularly prone to developing FSGS. [17][18][19][20][21] These studies point to the importance of hemodynamic factors, namely pregnancyrelated hyperfiltration, in the pathogenesis of lesions. However, in keeping with what has been observed in patients with cancer treated with antiangiogenic drugs, it is possible that the imbalance between angiogenic and antiangiogenic factors is a contributing factor.…”

Section: Introductionmentioning

confidence: 99%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.

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“…Furthermore, we can postulate that the effect of pregnancy-associated hyperfiltration is higher in cases, such in our patient, in which kidney disease is at least partly related to hemodynamic stress on the remnant nephrons [29]. However, we lack the data to support clinical logic and, while scattered experience suggests that comprehensive clinical management including dietary counselling and moderate protein restriction may be of help in controlling proteinuria, the evidence is too scant to allow quantitative conclusions [30,31,32,33].…”

Section: Discussion: Counselling Issuesmentioning

confidence: 99%

Mitochondrial Disease (MELAS Syndrome) Discovered at the Start of Pregnancy in a Patient with Advanced CKD: A Clinical and Ethical Challenge

Santoro

Bella

Toscano

et al. 2019

JCM

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Pregnancy is a challenge in the life of a woman with chronic kidney disease (CKD), but also represents an occasion for physicians to make or reconsider diagnosis of kidney disease. Counselling is particularly challenging in cases in which a genetic disease with a heterogeneous and unpredictable phenotype is discovered in pregnancy. The case reported regards a young woman with Stage-4 CKD, in which “Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes” (MELAS syndrome), was diagnosed during an unplanned pregnancy. A 31-year-old Caucasian woman, being followed for Stage-4 CKD, sought her nephrologist’s advice at the start of an unplanned pregnancy. Her most recent data included serum creatinine 2–2.2 mg/dL, Blood urea nitrogen (BUN) 50 mg/dL, creatinine clearance 20–25 mL/min, proteinuria at about 2 g/day, and mild hypertension which was well controlled by angiotensin-converting enzyme inhibitors (ACEi); her body mass index (BMI) was 21 kg/m2 (height 152 cm, weight 47.5 kg). Her medical history was characterized by non-insulin-dependent diabetes mellitus (at the age of 25), Hashimoto’s thyroiditis, and focal segmental glomerulosclerosis. The patient’s mother was diabetic and had mild CKD. Mild hearing impairment and cardiac hypertrophy were also detected, thus leading to suspect a mitochondrial disease (i.e., MELAS syndrome), subsequently confirmed by genetic analysis. The presence of advanced CKD, hypertension, and proteinuria is associated with a high, but difficult to quantify, risk of preterm delivery and progression of kidney damage in the mother; MELAS syndrome is per se associated with an increased risk of preeclampsia. Preterm delivery, associated with neurological impairment and low nephron number can worsen the prognosis of MELAS in an unpredictable way. This case underlines the importance of pregnancy as an occasion to detect CKD and reconsider diagnosis. It also suggests that mitochondrial disorders should be considered in the differential diagnosis of kidney impairment in patients who display an array of other signs and symptoms, mainly type-2 diabetes, kidney disease, and vascular problems, and highlights the difficulties encountered in counselling and the need for further studies on CKD in pregnancy.

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Pregnancy Is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis in Women with a History of Very Low Birth Weight

Cited by 5 publications

References 14 publications

Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis

Association of low birthweight and premature birth with hypertensive disorders in pregnancy: a systematic review and meta-analysis

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Mitochondrial Disease (MELAS Syndrome) Discovered at the Start of Pregnancy in a Patient with Advanced CKD: A Clinical and Ethical Challenge

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