Abstract: FR-PO0989
Empiric Treatment of Suspected De Novo Glomerular Disease in the Third Trimester of Pregnancy
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
- Thomson, Holly, Oregon Health & Science University, Portland, Oregon, United States
- Mistry, Nupur, Oregon Health & Science University, Portland, Oregon, United States
Introduction
Chronic kidney disease complicates 3% of pregnancies. Among glomerular diseases (GN) discovered in pregnancy, focal segmental glomerulosclerosis, IgA nephropathy, and lupus nephritis are most common. This case highlights a treatment approach for suspected GN presenting late in pregnancy, when diagnosis cannot be safely established with kidney biopsy.
Case Description
A 36-year-old G1P0 woman was admitted at 32 gestation weeks (GW) for acute kidney injury (AKI) and proteinuria. Preexisting primary hypertension was managed with labetalol and amlodipine during pregnancy. Admission history and exam revealed mild ankle swelling and foamy urine. She reported no chest pain, dyspnea, headache, vision changes, abdominal pain, hematuria, joint pain, or rash. Blood pressure was 144/88 mmHg. Serum creatinine was 2.24 mg/dL, increased from 1.29 mg/dL at 21 GW. Serum albumin was 2.3 g/dL. Otherwise, complete metabolic panel and blood counts were unremarkable. Urine microscopy showed 2 red blood cells. A 24-hour urine collection had 6.9 gm protein, compared to 2.7 gm at 26 GW. There was no obstruction on kidney ultrasound. Selected serologic GN workup was unrevealing. Kidney biopsy was deferred due to advanced gestational age. A soluble fms-like Tyrosine Kinase-1 and placental growth factor ratio was pending. In the setting of controlled blood pressure and no indicative symptoms, her obstetric team had low concern for preeclampsia causing rapid AKI and nephrotic range proteinuria. She was started on prednisone 1 mg/kg daily for presumed active GN. Delivery was induced at 33 GW due to fetal growth restriction. Postpartum kidney biopsy revealed IgA nephropathy. She completed a prednisone taper and was later placed on budesonide, sparsentan, and dapagliflozin with benefit.
Discussion
Data and guidance are limited in the rare situation when GN presents de novo during pregnancy. This case was particularly challenging, since third trimester presentation precluded tissue diagnosis. Carefully weighing risks and benefits, we recommended empiric corticosteroids to target multiple possible GN etiologies. Third trimester steroid use is generally considered safe for the fetus, with the main risk being reversible immunodepression. Maternal effects can include weight gain, hypertension, and diabetes. The benefit of limiting pregnancy complications and maternal kidney function loss from active GN outweighed these risks.