Abstract: TH-PO0540
When Biopsy Raises More Questions Than Answers: Immune-Mediated Glomerulonephritis (GN) in a Pregnant Appalachian Woman
Session Information
- Glomerular Diseases: IgAN, IgA Vasculitis, and More
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Desai, Anjali, Appalachian Regional Healthcare Inc, Whitesburg, Kentucky, United States
- Jain, Riddhi, Appalachian Regional Healthcare Inc, Whitesburg, Kentucky, United States
- Khan, Muhammad Sheheryar, Appalachian Regional Healthcare Inc, Whitesburg, Kentucky, United States
Introduction
Pregnancy-induced renal changes can unmask or mimic glomerular disease, and while early proteinuria may reflect normal adaptation, nephrotic-range proteinuria is always pathological. This overlap complicates distinguishing pregnancy-related nephropathy from primary GN, often requiring biopsy despite its procedural risks.
Case Description
29-year-old woman, G2P1, with a history of preeclampsia (preterm delivery at 34 weeks) and subsequent chronic hypertension, presented at 8 weeks gestation with nephrotic-range proteinuria (total protein 3.5 g/24h), microscopic hematuria, and chronic left lower extremity edema, prompting nephrology referral in the absence of prior baseline labs. Given nephrotic-range proteinuria, hematuria, morbid obesity, Kidney biopsy was planned in the first trimester to minimize risk. Light microscopy showed 1 of 23 globally sclerosed glomeruli, mildly increased mesangial matrix and cellularity, minimal interstitial fibrosis (<5%), and no crescents, necrosis, GBM breaks, vasculitis, or TMA. IF was complex, showing trace IgM, 2–3+ IgA, 1–2+ IgG, 2+ C1q, and 2+ C3, trace to negative kappa light chain, trace IgM. Biopsy was re-read at two different major academic centers confirming immune-mediated glomerulonephritis (GN)-unknown etiology; IgA nephropathy, PGNMID, vasculitic/pauci-immune GN, and anti-GBM were excluded. Despite exhaustive workup with negative serologies (ANA, anti-Smith, anti-SSA, anti-SSB, ANCA, anti-MPO, anti-PR3, C3/C4, ASO, hepatitis panel), etiology remained unclear. With no definitive disease on biopsy, negative serologies, declining proteinuria(3.5 g/24h--> 2.2 g/24h), and ongoing pregnancy, immunosuppression was deferred through shared decision-making. Management focused on enoxaparin (VTE prophylaxis), aspirin (preeclampsia prevention), and labetalol with close BP monitoring.
Discussion
Renal biopsy showed a "full-house" IF pattern, a rare entity without clinical or serologic evidence of SLE. NLFHN- a rare and poorly defined entity occurring in the absence of clinical or laboratory evidence of SLE but the pathologist weren’t convinced of that particular diagnosis. Pregnancy was considered coincidental, as histology suggests a process predating conception. Immunosuppression was deferred per 2021 KDIGO guidelines favoring conservative management for indolent immune-complex GN without obvious etiology.