Nephrotic syndrome during pregnancy. Is it chronic glomerulonephritis or preeclampsia? Case report

Cover Page

Cite item

Full Text

Abstract

Nephrotic syndrome (NS) during pregnancy is a fairly rare pathology and its descriptions in the literature are few. For a long time, NS was associated only with an exacerbation of chronic glomerulonephritis or de novo nephritis, however, the experience of recent years has shown that NS can be a manifestation of the classical obstetric pathology – preeclampsia (PE). The appearance of massive proteinuria with the development of NS is most typical for early PE, which, of course, makes diagnosis difficult, especially if PE develops at an unusually early time (up to 20 weeks). To describe PE that does not fit into the classical criteria, the term “atypical” PE is now used, the development of which can be promoted by both obstetric and somatic risk factors. The presented clinical observation describes the development of early (within 14 weeks) severe PE with the NS at the onset of the disease in a patient with the first multiple pregnancy and complete hydatidiform mole (HM) of one of the fetuses. The progression of nephropathy with the addition of thrombotic microangiopathy and HELLP syndrome made it possible to assume the diagnosis of PE with a high probability. The rapid relief of all clinical manifestations after delivery confirmed this assumption. The role of HM as the main trigger of unusually early PE is discussed. Apparently, the patient's trophoblast disease in the form of hydatidiform mole caused the formation of a severe angiogenic imbalance already in the early stages of pregnancy, which led to the development of PE, which manifested NS as a consequence of podocytopathy due to VEGF deficiency. Thus, the development of NS in a pregnant patient without a history of kidney disease dictates, first of all, the exclusion of PE, until proven otherwise.

About the authors

Maria V. Alekseeva

People’s Friendship University of Russia (RUDN University)

Author for correspondence.
Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0002-6761-3827

аспирант каф. внутренних болезней с курсом кардиологии и функциональной диагностики им. В.С. Моисеева ФГАОУ ВО РУДН

Russian Federation, Moscow

Natalia L. Kozlovskaya

People’s Friendship University of Russia (RUDN University); Yeramishantsev City Clinical Hospital

Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0002-4275-0315

д-р мед. наук, проф., проф. каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, рук. Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Yulia V. Korotchaeva

Yeramishantsev City Clinical Hospital; Sechenov First Moscow State Medical University (Sechenov University)

Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0002-0880-6346

канд. мед. наук, врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева», доц. каф. внутренних, профессиональных болезней и ревматологии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow; Moscow

Kseniya A. Demyanova

People’s Friendship University of Russia (RUDN University); Yeramishantsev City Clinical Hospital

Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0001-8927-5841

канд. мед. наук, доц. каф. внутренних болезней с курсом функциональной диагностики и кардиологии им. В.С. Моисеева ФГАОУ ВО РУДН, врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

Ayana G. Chegodaeva

Yeramishantsev City Clinical Hospital

Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0003-2049-9219

врач-нефролог Центра помощи беременным с патологией почек ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow

Sergey V. Apresyan

People’s Friendship University of Russia (RUDN University); Yeramishantsev City Clinical Hospital

Email: alekseeva.mari.vl@yandex.ru
ORCID iD: 0000-0002-7310-974X

д-р мед. наук, проф. каф. акушерства и гинекологии с курсом перинатологии Медицинского института ФГАОУ ВО РУДН, зам. глав. врача по акушерско-гинекологической помощи ГБУЗ «ГКБ им. А.К. Ерамишанцева»

Russian Federation, Moscow; Moscow

References

  1. Studd JW, Blainey JD. Pregnancy and the nephrotic syndrome. Br Med J. 1969;1:276-80. doi: 10.1136/bmj.1.5639.276
  2. De Castro I, Easterling TR, Bansal N, Jefferson JA. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017;91(6):1464-72. doi: 10.1016/j.kint.2016.12.019
  3. Brown RA, Kemp GJ, Walkinshaw SA, Howse MLP. Pregnancies complicated by preeclampsia and non-preeclampsia-related nephrotic range proteinuria. Obstet Med. 2013;6(4):159-64. doi: 10.1177/1753495X13498382
  4. Karumanchi SA, Maynard SE, Stillman IE, et al. Preeclampsia: a renal perspective. Kidney Int. 2005;67:2101-13. doi: 10.1111/j.1523-1755.2005.00316.x
  5. Меркушева Л.И., Козловская Н.Л. Поражение почек при преэклампсии: взгляд нефролога. Обзор литературы. Нефрология. 2018;22(2):30-8 [Merkusheva LI, Kozlovskaya NL. Renal injury in preeclampsia: the view or nephrologist. Literature review. Nephrology. 2018;22(2):30-8 (in Russian)]. doi: 10.24884/1561-6274-2018-22-2-30-38
  6. Lokki AI, Heikkinen-Eloranta J. Pregnancy induced TMA in severe preeclampsia results from complement-mediated thromboinflammation. Human Immunol. 2021;82:371-8. doi: 10.1016/j.humimm.2021.03.006
  7. American College of Obstetricians and Gynecologists. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-31. doi: 10.1097/01.AOG.0000437382.03963.88
  8. Шалина Р.И., Михалева Л.М., Симухина М.А., и др. Особенности клинического течения тяжелых форм преэклампсии в современных условиях. Вопросы гинекологии, акушерства и перинатологии. 2017;16(6):16-23 [Shalina RI, Mikhalyova LM, Simukhina MA, et al. Modern features of the clinical course of severe forms of preeclampsia. Gynecology, Obstetrics and Perinatology. 2017;16(6):16-23 (in Russian)]. doi: 10.20953/1726-1678-2017-6-16-23
  9. Suzuki T, Ichikawa D, Nakata M, et al. Nephrotic syndrome due to preeclampsia before 20 weeks of gestation: a case report. BioMed Central Nephrol. 2020;21(1):240. doi: 10.1186/s12882-020-01876-9
  10. Berry EL, Iqbal SN. HELLP Syndrome at 17 Weeks Gestation: A Rare and Catastrophic Phenomenon. J Clin Gynecol Obstet. 2014;3(4):147-50. doi: 10.14740/jcgo297w
  11. Bornstein E, Barnhard Y, Atkin R, Divon MY. HELLP syndrome: a rare, early presentation at 17 weeks of gestation. Obstet Gynecol. 2007;110:525-7. doi: 10.1097/01.AOG.0000268512.26170.ad
  12. Tsirigotis P, Mantzios G, Pappa V, et al. Antiphospholipid syndrome: a predisposing factor for early onset HELLP syndrome. Rheumatol Int. 2007;28(2):171-4. doi: 10.1007/s00296-007-0386-6
  13. Imasawa T, Nishiwaki T, Nishimura M, et al. A case of “Pure” preeclampsia with nephrotic syndrome before 15 weeks of gestation in a patient whose renal biopsy showed glomerular capillary endotheliosis. Am J Kidney Dis. 2006;48(3):495-501. doi: 10.1053/j.ajkd.2006.05.024
  14. Sibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol. 2009;200(5):481-7. doi: 10.1016/j.ajog.2008.07.048
  15. Stevens AB, Brasuell DM, Higdon RN. Atypical preeclampsia – Gestational proteinuria. J Fam Med Prim Care. 2017;6:669-71. doi: 10.4103/2249-4863.222029
  16. De Castro I, Easterling TR, Bansal N, Jefferson JA. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017;91(6):1464-72. doi: 10.1016/j.kint.2016.12.019
  17. Козловская Н.Л., Меркушева Л.И., Кирсанова Т.В., и др. Дисбаланс плацентарных факторов ангиогенеза и клинические особенности «ранней» и «своевременной» ПЭ. Взгляд нефролога. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2014;1(1):13-21. Режим доступа: https://archivog.com/2313-8726/article/view/35458. Ссылка активна на 14.03.2023 [Kozlovskaya NL, Merkusheva LI, Kirsanova TV, et al. Angiogenesis placental factors imbalance and clinical features of «early» and «late» preeclampsia. Archive of Obstetrics and Gynecology V.F. Snigereva. 2014;1(1):13-21. Available at: https://archivog.com/2313-8726/article/view/35458. Accessed: 14.03.2023 (in Russian)].
  18. Thomas W, Griffiths M, Nelson-Piercy C, Sinnamon K. Pre-eclampsia before 20-week gestation: diagnosis, investigation and management. Clin Kidney J. 2012;5(6):597-9. doi: 10.1093/ckj/sfs101
  19. Zhao M, Yin Y, Guo F, et al. Placental expression of VEGF is increased in pregnancies with hydatidiform mole: possible association with developing very early onset preeclampsia. Early Hum Dev. 2013;89(8):583-8. doi: 10.1016/j.earlhumdev.2013.02.008
  20. Maynard SE, Min JY, Merchan J, et al. Excess placental soluble fms-like tyrosine kinase 1 (sFlt1) may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia. J Clin Investig. 2003;111(5):649-58. doi: 10.1172/jci17189
  21. Karumanchi SA, Maynard SE, Stillman IE, et al. Preeclampsia: A renal perspective. Kidney Int. 2003;67(6):2101-13. doi: 10.1111/j.1523-1755.2005.00316.x
  22. Moghaddas SH, Zununi VS, Ardalan M. Preeclampsia: A close look at renal dysfunction. Biomed Pharmacother. 2019;109:408-16. doi: 10.1016/j.biopha.2018.10.082
  23. Меркушева Л.И., Козловская Н.Л. Современные представления о патогенезе поражения почек при преэклампсии. Акушерство и гинекология. 2015;8:12-7 [Merkusheva LI, Kozlovskaya NL. Current ideas on the pathogenesis of renal injury in preeclampsia. Obstetrics and Gynecology. 2015;8:12-7 (in Russian)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2023 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies