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Kidney Week

Abstract: FR-PO586

Hyponatremia in Pregnancy and the Role of Renal Biopsy

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Pedley, Nathaniel, Columbia University Medical Center, New York, New York, United States
  • Canetta, Pietro A., Columbia University Medical Center, New York, New York, United States
  • Crew, Russell J., Columbia University Medical Center, New York, New York, United States
  • Stokes, Michael Barry, Columbia University Medical Center, New York, New York, United States
  • Khairallah, Pascale, Columbia University Medical Center, New York, New York, United States
Introduction

Preeclampsia is a serious pregnancy complication that may mimic nephrotic syndrome. Severe hyponatremia in preeclampsia is rare and presents a unique clinical challenge as it increases the risk of seizures, mimicking eclampsia. It can also lead to several maternal and fetal adverse events.

Case Description

We report the case of a 35yo G1P0 female who presented at 21 weeks of gestation with anasarca and vomiting. The pregnancy was conceived via in vitro fertilization and was uneventful until the day of presentation. She was found to be hypertensive to 152/84mm Hg with 4+ proteinuria on urine dispstick. Her labs were significant for creatinine of 0.7 mg/dL, serum albumin of 2.5 g/dL, Na of 117 mmol/L, and proteinuria of 12.5 g/g. Serum osmolality was 233 mOsm/Kg, UNa was <20 mmol/L and UOsm was 235 mOsm/Kg. Severe hyponatremia was secondary to low effective circulating volume from hypovolemia in the setting of vomiting and anasarca, and improved with albumin infusions. The combination of severe hyponatremia and proteinuria prompted a renal biopsy to identify the underlying cause of nephrotic syndrome. The biopsy showed diffuse severe glomerular thrombotic microangiopathy with endotheliosis, consistent with preeclampsia. The pregnancy was terminated with normalization of Na levels within 3 days postpartum and reduction in proteinuria to 2 g/g within 2 weeks postpartum.

Discussion

This case is the earliest by gestational age at which preeclampsia-induced hyponatremia has been reported. The rarity of this complication, combined with the early gestational age of preeclampsia onset and the desire of the patient to maintain her pregnancy, necessitated a definitive diagnosis to explain her clinical picture. The renal biopsy proved critical in determining the diagnosis and best course of therapeutic action.