Abstract: TH-PO148

Pregnancy in Women with Relapsing Minimal Change Disease – Experience of a Tertiary Centre

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Godinho, Iolanda, Imperial College London, London, United Kingdom
  • Webster, Philip, Imperial College London, London, United Kingdom
  • Lightstone, Liz, Imperial College London, London, United Kingdom
Background

Recent data suggest even patients with CKD stage 1 have an increased risk of pregnancy complications when compared to the general population. However, data on outcomes specifically in pregnant women with relapsing minimal change disease (MCD) are lacking. We now report the largest series to date.

Methods

Women with MCD were identified from our obstetric renal database from 1996-2016. We report maternal outcomes: relapse, AKI & worsening of renal function, HTN; & obstetric outcomes: number of successful pregnancies, preeclampsia, preterm delivery & low birth weight.

Results

Out of 797 pregnancies, we identified 14 in 10 women with MCD. Median maternal age: 35 years (19-40). Two patients had chronic HTN – one with relapsing MCD with IgM deposition for 11 years & 8 years of FK treatment; the other patient had dysmetabolic syndrome and MCD diagnosis made on post-partum biopsy. All women were in remission with no proteinuria at the time of conception & normal creatinine with CKD1 in 8, CKD2 in 6 using CKD-EPI eGFR. The majority (71%) of women were on immunosuppression (FK (n-7), CsA (n-2) or steroids (n-2) & one had an unplanned pregnancy diagnosed very soon after maintenance rituximab. None of the women developed worsening renal function. Relapses were seen in 2 pregnancies in women who stopped their maintenance immunosuppression. One hypertensive patient had worsening HTN during pregnancy. The majority of babies (69%, n=9) delivered at term (median gestation 38 weeks (range 28-40)). Preterm (35 & 36 weeks) & very preterm (28 weeks) were seen in 3 & 1 pregnancies respectively. Birth weight was 2923±622g. Just 1 baby had low birth weight (<2.5kg) & 1 very low (1.5kg). There was one miscarriage at 18 weeks. No women developed pre eclampsia & no congenital abnormalities were seen.

Conclusion

In this series, the largest reported to date, of women with CKD1/2 due to relapsing MCD, despite high rates of immunosuppression, pregnancies were largely uncomplicated (69%) & relapse rare unless maintenance immunosuppression stopped. Our data suggest pregnancies in MCD in remission are safe & that establishing secure remission especially with tacrolimus, is key to pregnancy planning. Our good results rely on pre-pregnancy counselling to optimise timing & medications & a highly experienced MDT obstetric renal antenatal clinic.