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Kidney Week

Abstract: TH-PO749

Preeclampsia or Lupus Nephritis in Pregnancy: The Role of Renal Biopsy

Session Information

Category: Women's Health and Kidney Diseases

  • 2100 Women's Health and Kidney Diseases

Authors

  • Santos, Angelie, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Singh, Tripti, University of Wisconsin-Madison, Madison, Wisconsin, United States
Introduction

Lupus nephritis (LN) in pregnancy is a significant risk factor for adverse obstetric outcomes, including preeclampsia and fetal demise. Preeclampsia and LN have similar manifestations, but treatment is different. Renal biopsy is indicated but there is limited knowledge on its role in pregnancy as it has its own risk. We present a challenging case of a pregnant woman with clinical features suggesting new-onset LN and manifested as preeclampsia at 25 weeks age of gestation (AOG).

Case Description

A 34-year-old female with history of benign ethnic neutropenia and thrombocytopenia, was found to have transaminitis, worsening thrombocytopenia and proteinuria of 5 grams at 19th week AOG. Labs also revealed positive antinuclear antibodies, positive anti-Ro, and negative double-stranded DNA. She was treated with steroids for 4 days which led to normalization of her platelet counts. She presented with acute kidney injury (AKI) with serum creatinine (SCr) increasing from 0.4 to 0.7 mg/dL and hypertension (HTN) at 24 weeks AOG. Work up revealed severe intrauterine fetal growth restriction (IUGR). She underwent kidney biopsy at 25 weeks AOG and was empirically started on LN treatment with steroids and hydroxychloroquine. Her course rapidly worsened with AKI (SCr 1.05 mg/dL), increasing proteinuria and hypoalbuminemia, HTN and symptoms of volume overload including ascites, pleural and pericardial effusions. Kidney biopsy revealed immune complex deposition consistent with lupus nephritis and endothelial cell injury consistent with preeclampsia. Emergent induction was planned, as expectant management becomes a contraindication. After induction and delivery to a demised fetus, AKI and HTN improved to baseline and proteinuria decreased to 4.5 grams/24 hours in 48 hours post-partum.

Discussion

The patient presented with AKI, HTN and nephrotic syndrome that can be seen in LN as well as preeclampsia. LN can be treated empirically with steroids, but establishing the diagnosis was essential, especially at 25 weeks AOG, as inducing delivery for preeclampsia would be fatal for the fetus due to IUGR.

In conclusion, distinguishing LN and preeclampsia is challenging, but rapid diagnosis is essential as complications can be fatal for both the mother and the fetus. Kidney biopsy is high risk in advanced pregnancies but is essential in management if there is diagnostic dilemma.