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Kidney Week

Abstract: PO2248

Clinical Context and Outcomes of Kidney Biopsy in Pregnant Women: An Institutional Review

Session Information

Category: Pathology and Lab Medicine

  • 1602 Pathology and Lab Medicine: Clinical

Authors

  • Gaddy, Anna R., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Trevino, Karen, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Phillips, Carrie L., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Taber-Hight, Elizabeth, Indiana University School of Medicine, Indianapolis, Indiana, United States
Background

Kidney biopsy is an excellent method of gaining insight to causes of renal decline but is not without risk, particularly in pregnant patients. While we await the era of biomarkers which enhance our ability to diagnose diseases of pregnancy, biopsy remains the most inclusive way of reaching a diagnosis. Clinical manifestations warranting biopsy include gross deterioration in renal function, de novo development of nephrotic syndrome, or suspicion for glomerulonephritis. A recent metanalysis found that the risk of complications during pregnancy was 7% and should be limited to patients in whom the diagnosis would warrant urgent therapy. We sought to explore indications for biopsy and histopathology in patients evaluated at our institution.

Methods

Our surgical pathology database was searched for renal biopsy specimens interpreted from 2008 to mid-2020. Patients were either pregnant at the time of biopsy or within 3 months postpartum. Indiana University IRB approved the study. A chart review was completed to obtain lab data at the time of biopsy and post procedure.

Results

We identified biopsy specimens from 38 women who were pregnant during the specified time period. Histopathologic diagnoses included lupus nephritis (n=4), FSGS (8), diabetic kidney disease (3), allergic interstitial nephritis (1), IgA (10) and minimal change disease (3).Chart information was available for 19 women including 15 Caucasian and 4 African American patients, with a mean age of 28.6 years. Eight specimens were obtained during pregnancy and 11 during the postpartum period. Proteinuria was present in 17 patients with a mean value of 3.5g/d. Hematuria was also present in 14 of the patients. Mean serum creatinine was 2.6mg/dL.

Conclusion

Renal biopsy is a procedure with high risk and morbidity for pregnant women. At our institution, biopsy was performed for either worsening renal function or proteinuria. Our population showed diverse diagnoses which justified need for biopsy, including requiring urgent intervention. Our study highlights the need of judicious biopsy in pregnant women. Further studies can be done to determine long term kidney outcomes in pregnant women.