Abstract: FR-PO734
Nephrotic Syndrome During Pregnancy: Not Everything Is Preeclampsia
Session Information
- Glomerular Diseases: Podocyte Biology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1304 Glomerular Diseases: Podocyte Biology
Authors
- Aguilar, Rita Belinda, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
- Gomez Villarreal, Juan Pablo, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
- Morcos sandino, Michelle, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
- Guerrero Gonzalez, Elisa Maria, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
- Rizo Topete, Lilia Maria, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León, Mexico
Introduction
Nephrotic syndrome (NS) rarely presents during pregnancy, the incidence owing to primary glomerular disease is unknown due to difficulty in differentiating it from preeclampsia. NS increases maternal and fetal adverse outcomes and confers risk for many complications including AKI and thromboembolic events. We present a case of a woman who developed progressive edema during second and third trimester of pregnancy, she underwent approach until a diagnosis of polyhydramnios was made.
Case Description
30 year old female who was going through third trimester pregnancy, without history of chronic illness developed anasarca and polyhydramnios. On admission she underwent amniocentesis of 2L, hours later she started with uterine activity and went into labor. Laboratory results at admission revealed SCr 1.3mg/dl, BUN 18mg/dl, serum albumin 1g/dl, urinalysis with proteinuria ++++, RBC 12/field, WBC 10/field, 24hr protein quantification was performed with 11.4gr/1340ml; Nephrology department was consulted. Patient was stable, no hypertension developed during hospitalization and a diagnosis of NS was made. We started IV furosemide, atorvastatin and enoxaparin, At day 12 of puerperium kidney biopsy was performed and included 24 glomeruli (2 glomeruli with global sclerosis and 4 with segmental sclerosis) immunofluorescence staining showed glomerular deposition of albumin; IgG, IgA, C3 and fibrinogen were negative. Based on findings she was diagnosed with Tip Lesion variant Focal and Segmental Glomerulosclerosis, steroid therapy was initiated with oral prednisone at dose of 50mg/day, four weeks after initiation of steroid therapy patient had a 24h protein quantification of 450mg, SCr 0.7mg/dl, serum albumin increased to 4.2g/dl and edema disappeared.
Discussion
In this case we faced to a pregnant patient with anasarca, heavy proteinuria and hypoalbuminemia in the absence of hypertension. We started treatment based on steroid as the primary regimen with close monitoring due to increased risk for thrombosis. AKI developed during hospitalization but patient had rapid recovery of renal function and went into complete remission.