Introduction:
Primary glomerular diseases frequently affect women in childbearing age. There is a dearth of information about the impact of pregnancy on the outcomes, posing difficulties to the treating nephrologists. This retrospective cohort study examines pregnancy outcomes in women with biopsy-proven primary glomerular disease and the impact on renal survival.
Methods:
We assessed the medical records of women in child bearing age (18-45 years) diagnosed with biopsy proven primary glomerular disease (IgA N, FSGS, MGN, MCD) from 2012- 2022 at a single centre. Patients with end stage kidney disease (ESKD) at the time of biopsy and/or at time of conception and those who had undergone kidney transplantation were excluded. Pregnancy (preterm delivery, intra uterine growth restriction, mode of delivery, pre-eclampsia) and Kidney outcomes (relapse, renal disease progression) were recorded. Relapse was defined as increase in proteinuria to ≥3.5g/day (≥1g/day for IgAN) pregnancy and renal disease progression as >40% sustained decline in eGFR and/or ESKD.
Results:
Of 238 women assessed, 81 were lost to follow up and 125 did not conceive after biopsy. 44 pregnancies were documented in 32 women (IgAN n=21, FSGS n=6, MGN n=10, MCD n=7). The median age of conception was 28.5 (25.2-33.0) years and the median time from biopsy to conception was 3 (2-5.8) years.15 pregnancies (34%) were medically terminated, 4 (9%) resulted in spontaneous abortions, and 25 (57%) culminated in live births.12 (27%) pregnancies occurred while the patient was on ACEi/ARBs of which 7 resulted in live births. 12 out of 25 live births were premature and IUGR below 10th percentile affected 15 pregnancies.72% deliveries were by caesarean section. Preeclampsia affected 6 pregnancies. From a renal perspective, 9(28%) women had active disease at conception. 7 (33%) women relapsed during pregnancy and 2 (9.5%) relapsed immediate postpartum of whom 8 received steroids. In 6 women, eGFR decreased by > 40 percent compared to their baseline (at biopsy) following the pregnancy but one progressed to ESKD.
Conclusions:
Pregnancy is associated with adverse maternal and fetal outcomes in women with primary glomerular diseases.
The content presented in this abstract was submitted for American Society of Nephrology (ASN) Kidney Week 2024. Resubmitting this abstract is permitted by ASN.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.