Abstract: PO2608
Anti-Glomerular Basement Membrane Disease in Pregnancy
Session Information
- Women's Health and Kidney Diseases
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 2000 Women’s Health and Kidney Diseases
Authors
- Lodhi, Fahad Aftab khan, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Umukoro, Peter Eloho, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Sajjad, Syed, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Blonsky, Rebecca, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
Introduction
Anti-glomerular baseline membrane (anti-GBM) disease is a rare cause of renal failure due to the production of IgG antibodies against type IV collagen. Its occurrence during pregnancy is even less common and can lead to poor maternal and fetal outcomes.
Case Description
A 23-year-old female with history of depression presented at 15 weeks 3 days gestation with weakness, nausea and vomiting for one week and anuria for 24 hours. Labs were significant for a creatinine of 19.8 mg/dL, BUN 113 mg/dL and potassium 7.1 mmol/L. Labs six months prior were normal. Nephrology was consulted and the patient was transferred to the intensive care unit for urgent hemodialysis. Further serologic investigation revealed elevated anti-GBM antibodies. A kidney biopsy was performed which demonstrated 100% cellular crescents on light microscopy and linear deposits on immunofluorescence, confirming the diagnosis.
In addition to daily hemodialysis, the patient underwent plasmapheresis and immunosuppression with pulse dose steroids followed by a steroid taper as well as azathioprine and tacrolimus.
The patient returned to the hospital with hypoxic respiratory failure due to parainfluenza virus further complicated by pre-term premature rupture of membranes at 24 weeks 4 days. As the patient had no signs of renal recovery, her immunosuppression was discontinued. The patient remained inpatient receiving daily hemodialysis until 28 weeks 0 days when the patient developed uncontrollable hypertension requiring an emergent cesarean section. The patient gave birth to a live male weighing 1.1 kg. Her post-partum course was uncomplicated, though the patient remains dialysis dependent.
Discussion
The treatment of choice in anti-GBM disease is plasmapheresis to remove circulating antibodies and immunosuppression to reduce antibody production. However, pregnancy presents a unique challenge in choosing immunosuppressive agents as both maternal and fetal effects need to be considered. The involvement of high risk obstetrics as well as neonatology in the care of these patients is imperative to ensure the best possible outcomes.