Relationship between histopathological changes in post partum renal biopsies and renal function tests of African women with early onset pre-eclampsia

Abstract

Renal biopsy procedure is safe, and ultrastructural and histological findings obtained from postpartum renal biopsies are more informative than the routine renal function tests.

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

“…complications were reported in about 1.3% of biopsies). Loin pain was cited in 12 women in one study; however, as the Abstract and Discussion of this paper reported that ‘no complication’ had occurred, this loin pain was assumed to have been mild and was not considered as a complication in our analysis . The figure of 1.3% for the rate of complications is significantly lower than that found during pregnancy ( P = 0.008).…”

“…Some conclusions were in disagreement: kidney biopsy in pregnancy was considered safe in two studies but a choice to be avoided where possible in others; the most recent study, available as an abstract, reported ‘uneventful recovery’ and drew very cautious conclusions (Table ). On other issues, there was substantial agreement: no clinical or serological marker was found to be able to discriminate between pre‐eclampsia and underlying kidney disease, and the histological changes of pre‐eclampsia did not reflect the severity of the disease (the finding of glomerular endotheliosis also in healthy controls in the most recent study on kidney biopsy in pregnancy further supports this conclusion) …”

“…In our search for articles related to kidney biopsy and pregnancy, 51 full‐text articles were retrieved from 949 references (297 from Medline, with the limit ‘human’, 632 from Embase, 17 from CHINAL and three from the Cochrane Library). After the exclusion of four papers as duplicates, 39 fulfilled the selection criteria (Figure ) . Of these, five studies dealt with kidney biopsy in pregnancy only, six included women who underwent a kidney biopsy in pregnancy and after delivery, and 28 included biopsies performed only after delivery (Table ).…”

Author's Reply

“…Since then, biopsy techniques have vastly improved, notably in our group, drawing on the traditions of Dr Claus Brun, who developed the technique in 1951. Modern renal biopsy studies in pre‐eclampsia have similarly not reported any complications and have concluded the procedure to be safe in the research setting 7–10 . Even so, our patients were told that renal haematoma or haematuria could occur at a rate of 1/59–111 4,6 .…”

Alterações ultra-estruturais do glomérulo na pré-eclâmpsia

“…A partir da década de 60 descreveram-se outras lesões glomerulares nas pacientes com préeclâmpsia, demonstrando que o edema da célula endotelial não era a única alteração nesta doença [3][4][5][6][7][8][9][10][11][12][13] . Assim, alguns autores mostravam a expansão e interposição mesangial entre a membrana basal e o endotélio 3,5,7,9 .…”