Abstract: TH-PO1012
Three Cases of FSGS and Thrombotic Microangiopathy Presenting in Pregnancy: Experience in a Single Center
Session Information
- Women's Health and Kidney Diseases
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Perlmutter, Jason Jessie, Albany Medical College, Albany, New York, United States
- Singh, Pratiksha, Albany Medical College, Albany, New York, United States
- Beers, Kelly, Albany Medical College, Albany, New York, United States
Introduction
The association between pregnancy and focal segmental glomerulosclerosis (FSGS) is not fully understood. Symptoms of FSGS such as proteinuria, edema, and HTN are also seen clinically with preeclampsia. We present three cases at an academic medical center with FSGS on biopsy after presenting with preeclampsia with severe features.
Case Description
The first is a 33F G1P0 presenting at 27w0d with HTN, edema, AKI, and proteinuria of 13,672mg that did not improve post-delivery. Serological GN workup negative. Kidney biopsy (bx) suggested primary FSGS with interstitial fibrosis and tubular atrophy (IFTA). She was treated with 16 weeks of prednisone, SGLT-2i, and ARB. Remission achieved in 6 months. Genetic testing negative. The second is a 25F G1P0 with AKI, hypertension, edema, and proteinuria of 10,472mg without improvement with delivery. She underwent kidney bx which showed FSGS, chronic thrombotic microangiopathy (TMA), minimal IFTA. Proteinuria resolved spontaneously. Our third is a 26F G1P0 with T2DM, HTN, PCOS who presented at 33w3d with HTN and 24h urine protein of 4578mg. Kidney bx showed acute TMA and FSGS. Testing found elevated complement factor I and factor B with negative genetic testing. She is currently being treated with ravulizumab-cwvz.
Discussion
These cases illustrate the heterogeneity of patients with FSGS / TMA in pregnancy. The most common finding in kidney biopsies of pregnancy is FSGS. Our center found significant heterogeneity in these patients with different representative outcomes. Pregnancy may be a trigger of glomerular disease and preexisting glomerular disease increases risk of preeclampsia. Further studies are needed to better risk-stratify patients with preeclampsia to guide management of the pregnancy and glomerular disease.
Summary Of Cases
| Patient | A | B | C |
| History | 33F G1P0 presented at 27w0d, no risk factors | 25F G1P0 presented 27W06D, no risk factors | 26F G1P0, DM, HTN, PCOS, presented at 33W3D |
| BP (Max) | 159/97 | 151/103 | 172/89 |
| Proteinuria (mg) | 13672 | 10472 | 4578 |
| Peak Creatinine (Baseline Creatinine) | 1.23 (0.53) | 1.26 (0.9) | 0.89 (0.54) |
| Albumin (min, g/dL) | 2.4 | 2.5 | 2.6 |
| Renal Pathology | FSGS, no active TMA, minimal IFTA | FSGS, chronic TMA, minimal IFTA | Focal acute and chronic TMA, FSGS, diabetic nephropathy w/ nodular glomerulosclerosis, mild IFTA |
| Placental Pathology | Small placental weight, focal infarction | Small placental weight, no specific pathological dx. | Small placenta, decidual vessels with mild hypertrophic change vasculoapthy, fibrinoid degeneration, and perivascular chronic inflammation, subchorial hematomas, unremarkable fetal membranes |
| Complement | C3, C4 WNL | Complement HUS panel pending. C3 and C4 WNL | C3 and C4 WNL, elevated factor I and factor B levels. |
| Genetics | ALG-1 Mutation, none associated w/ FSGS | Negative | Negative |
| Treatment | 16W steorids, MRA, SGLT-2i, ARB | Supportive Care | Ravulizumab-cwvz, SGLT2i-2i, ARB |
| Outcome | Remission achieved in 6 months with therapy | Rapidly downtrending PCR. UA 3 month later WNL. | Treatment underway |