Abstract: FR-PO0988
A Diagnostic Dilemma in Pregnancy for Phospholipase A2 Receptor (PLA2R)-Negative Membranous Nephropathy
Session Information
- Women's Health and Kidney Diseases
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Women's Health and Kidney Diseases
- 2100 Women's Health and Kidney Diseases
Authors
- Pasrija, Urvishkumar, University of Illinois Chicago, Chicago, Illinois, United States
- Madrid, Bianca, John H Stroger Jr Hospital of Cook County, Chicago, Illinois, United States
- Amarah, Amatur R., University of Illinois Chicago, Chicago, Illinois, United States
Introduction
Glomerular disease during pregnancy poses significant diagnostic and therapeutic uncertainty, often necessitating empiric management after fetal viability when a kidney biopsy is deferred due to procedural risk.
Case Description
A 27-year-old Hispanic primigravida presented at 24 weeks gestation with nephrotic syndrome characterized by severe hypoalbuminemia (<1.5 g/dL) and nephrotic-range proteinuria (UPCR 7.5 g/g) with preserved GFR. Serologic workup was notable for positive ANA (<1:160), anti-SSA (>8), and anti-SSB (3.1) antibodies; renal imaging was unrevealing. Due to advanced gestation, kidney biopsy was deferred and she was treated empirically with prednisone and low-molecular-weight heparin. Proteinuria gradually improved and she delivered a live but small-for-gestational-age infant at 37 weeks gestation. Corticosteroids and anticoagulation were continued for six weeks postpartum. At 8-week postpartum, kidney biopsy was performed after near remission of proteinuria (UPCR 0.5 g/g), confirmed PLA2R-negative membranous nephropathy. Conservative management was continued given spontaneous remission.
Discussion
Diagnosing glomerular disease during pregnancy is challenging because presentations often overlap with hypertensive disorders of pregnancy and progression of pre-existing proteinuric CKD. Membranous nephropathy in pregnancy carries increased maternal and fetal risks. Management is mainly supportive, including edema control, blood pressure management, and thromboprophylaxis, as many immunosuppressive agents are contraindicated. While KDIGO provides no pregnancy-specific guidance for membranous nephropathy, glucocorticoids, azathioprine, and calcineurin inhibitors are generally considered the safest options when immunosuppression is necessary. This case highlights that clinical improvement with empiric corticosteroids may not predict the underlying pathology and that histologic resolution can lag behind clinical remission. Kidney biopsy is generally considered safe before 28 weeks gestation, and remains essential for definitive diagnosis and management.