NDT Advance Access originally published online on August 25, 2007
Nephrology Dialysis Transplantation 2008 23(1):201-206; doi:10.1093/ndt/gfm572
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The role of renal biopsy in women with kidney disease identified in pregnancy
1Dept of Nephrology, University Hospital, Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH and 2Dept of Fetal Medicine, Birmingham Women's; Health Care NHS Trust, Birmingham, B15 2TG
Correspondence to: Dr Graham Lipkin, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. Email: graham.lipkin{at}uhb.nhs.uk
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Abstract |
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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.
Keywords: chronic kidney disease; pre-eclampsia; pregnancy; proteinuria; renal biopsy
Received for publication: 11. 2.07
Accepted in revised form: 26. 7.07