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Kidney Week

Abstract: PO1622

Anti-Glomerular Basement Membrane Disease in Pregnancy

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Li, Anna S., The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, United Kingdom
  • Abdullah, Shahid, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, United Kingdom
  • Szeki, Iren, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, United Kingdom
  • Brix, Silke R., The University of Manchester Faculty of Biology Medicine and Health, Manchester, Manchester, United Kingdom
Introduction

Anti-glomerular basement membrane (GBM) vasculitis is a rare immune mediated inflammation resulting in organ- and life-threatening disease. Presentation during pregnancy presents an additional challenge to preserve organ function and life of the unborn child.

Case Description

We report the case of a 23-year-old woman, 18 weeks pregnant, presenting with haemoptysis and acute kidney injury. Her chest X Ray demonstrated multilobar consolidation with perihilar prominence consistent with pulmonary haemorrhage. Her blood tests detected an anaemia (Hb 51 g/L) and kidney failure (eGFR 17 ml/min). Her GBM antibody was 30.3 AI. She received daily plasma exchange (PLEX) for 7 days until her GBM antibody normalised. Additionally, she was commenced on 1gram of cyclophosphamide, and following her plasma exchange sessions she received 1gram of rituximab. Her acute kidney injury progressed (eGFR 13 ml/min), and renal replacement therapy was initiated to manage fluid overload and for foetal health. She remained 8 days in the high dependency unit on high flow oxygen therapy due to respiratory failure due to her diffuse alveolar haemorrhage needing daily transfusions to maintain her haemoglobin. Daily gynaecology reviews were performed. Post rituximab, PLEX was recommenced after 72 hours and continued daily for another week with 13 sessions in total. The patient stabilised, renal replacement therapy was discontinued, and she was discharged after a hospital stay of 27 days. Her baby was delivered via caesarean section due to the development of preeclampsia at week 28 gestation. Twelve months later, patient and baby are healthy with normal development per percentile, and patient’s kidney function has recovered with a current eGFR of 86 ml/min.

Discussion

Timely and aggressive therapy is crucial to salvage kidney function in anti-GBM disease. Here, we present a case of a pregnant patient highlighting that a certain amount of cyclophosphamide is acceptable in life-threatening maternal conditions. Additionally, we demonstrate the possibility to significantly reduce cyclophosphamide in anti-GBM disease by adding in rituximab.