The role of renal biopsy in women with kidney disease identified in pregnancy

Clara Day, Peter Hewins, Sarah Hildebrand, Lumaan Sheikh, Gabrielle Taylor, Mark Kilby, Graham Lipkin

Research output: Contribution to journalArticlepeer-review

59 Citations (Scopus)

Abstract

Background. Renal disease may present for the first time in pregnancy, either as symptomatic disease or as a consequence of antenatal screening. The role of antenatal and post-partum percutaneous renal biopsy in the management of such patients is discussed. Methods. We describe two series of women; the first is a series of 20 women presenting with renal disease of a severity to warrant renal biopsy during pregnancy whilst the second, comprises 75 women who had an initial presentation of renal disease in pregnancy and underwent post-partum renal biopsy. Results. Biopsy during pregnancy revealed a glomerular disorder in 19/20 (95%) with immediate change of management in 9/20 (40%). In 17/20 (85%) there was delivery of a live infant at median gestation of 36 weeks (range 25-40). Follow-up of women [median 103.3 months (2.5-256)] showed 9/20 (45%) had a GFR of <60 ml/min/1.73 m2 [six at end-stage renal failure (ESRF)] and 3/20 were dead. The majority (62/75; 82.6%) of women undergoing post-partum renal biopsy presented with significant proteinuria (40% pre-eclampsia) during pregnancy not resolving post-partum. A glomerular abnormality was found in 64%. At last follow-up of 47 women [median 51.5 months (range 1-212)], 14 patients (29.7%) had significant proteinuria and 20 (42.6%) had a GFR<60 ml/min/1.73 m2. Six women (12.7%) had ESRF. Conclusions. Diagnosis and follow-up of renal disease diagnosed in pregnancy is important as progressive disease occurs in this group. Routine antenatal screening provides a useful diagnostic opportunity to detect asymptomatic renal disease. In a selected sub-group, renal biopsy during pregnancy can be helpful in initiation of correct treatment and allowing progression of pregnancy to fetal viability.

Original languageEnglish
Pages (from-to)201-206
Number of pages6
JournalNephrology Dialysis Transplantation
Volume23
Issue number1
DOIs
Publication statusPublished - Jan 2008
Externally publishedYes

Keywords

  • Chronic kidney disease
  • Pre-eclampsia
  • Pregnancy
  • Proteinuria
  • Renal biopsy

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