Postpartum fsgs

BACKGROUND: Contemporary data regarding pregnancy outcomes in US patients with primary glomerular diseases are lacking. We aimed to report fetal and maternal outcomes among women with biopsy-proven primary glomerular disease who received obstetric care at a single large academic US center. METHODS: All women with a biopsy-confirmed primary glomerular disease diagnosis and without end-stage kidney disease who received obstetric care at the University of North Carolina (UNC) Hospitals (1996-2015) were identified using the Glomerular Disease Collaborative Network registry and the UNC Hospitals Perinatal Database...

BACKGROUND AND OBJECTIVES: For many women pregnancy is the first contact with health services, thus providing an opportunity to identify renal disease. This study compares causes and long-term renal outcomes of biopsy-proven renal disease identified during pregnancy or within 1 year postpartum, with nonpregnant women. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Native renal biopsies (1997-2012), in women of childbearing age (16 to <50 years), from 21 hospitals were studied...

BACKGROUND: Many studies have investigated preexistent renal disease during pregnancy. However, insufficient data regarding the new onset of glomerulonephritis in the course of gestation, especially in patients with preeclampsia, exist. The aim of this study was to investigate underlying renal disease in preeclamptic Turkish women with persistent proteinuria after delivery. METHODS: Between 2005 and 2010, 463 patients with preeclampsia were admitted to our hospital...

Renal insufficiency occurs in a considerable proportion of patients with sickle cell disease. Common advanced glomerular lesions include focal segmental glomerulosclerosis and nonimmune membranoproliferative glomerulonephritis. Due to the paucity of data supporting an immune-mediated pathophysiology, anti-inflammatory and immunosuppressive therapies have not been successfully evaluated in such patients. We present a case of membranoproliferative glomerulonephritis in a postpartum patient with sickle cell disease, where treatment with steroids was helpful...

Although pregnancy can cause hydronephrosis in native kidneys, renal transplant dysfunction during pregnancy due to obstruction is rare. A 22-week pregnant renal transplant patient presented with deteriorating renal function (serum creatinine 5.22 mg/dL from 2.07 mg/dL 3 weeks previously). Ultrasound showed transplant hydronephrosis with the graft compressed between the gravid uterus and liver. Percutaneous nephrostomy was placed with improvement in graft function. The nephrostomy remained in situ for the rest of the pregnancy...

An unusual case of early nephrotic syndrome without hypertension which slightly resolved after delivery is documented. Renal biopsy was performed postpartum and the diagnosis was focal and segmental glomerulosclerosis with moderate chronic renal changes. It is questioned whether the case was due to preeclampsia or was the initial diagnosis of chronic renal disease which was made during pregnancy. The role of renal biopsy in such cases is briefly discussed (Tab. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.

Nephrotic syndrome occurs very rarely, about 0.012-0.025% of all pregnancies. Here, we report a rare case of early onset nephrotic syndrome developing de novo in the 17th week of pregnancy. A renal biopsy was done and the specimens revealed typical features of focal segmental glomerulosclerosis. The patient had a progressive clinical course of disease despite steroid treatment. Suffering from severe intrauterine growth restriction, the fetus died in utero. After delivery, steroid treatment was continued. The patient had normal renal function with a decrease in proteinuria in the second and fifth month postpartum...

Ultrastructural glomerular lesions of preeclampsia were studied by electron microscopy in 39 biopsy specimens from 36 patients. Postpartum biopsy obtained on day 0 revealed marked narrowing of the capillary lumen due to endothelial cell swelling, massive subendothelial and mesangial deposits containing lipids and fibrillar fibrins, monocyte invasion in the mesangium, and rupture and duplication of the glomerular capillary wall. Duplication of the glomerular capillary wall generally consisted of the glomerular basement membrane (GBM) and a newly formed mesangial matrix associated with mesangial interposition...

BACKGROUND: Focal segmental glomerulosclerotic lesion (FSGS lesion) is frequently observed in preeclamptic patients with nephrotic syndrome. PATIENTS AND METHODS: We performed a morphometric analysis of renal biopsies from 20 patients with severe preeclampsia to evaluate the pathogenetic role of glomerular hypertrophy in preeclamptic nephropathy associated with FSGS lesion. We also analyzed biopsies obtained from 6 preeclamptic patients without FSGS lesion and 10 patients with isolated hematuria...

Renal biopsies from hypertensive pregnant women performed 8 to 10 days postpartum were processed by morphometric analysis. We allocated the 74 patients into four groups according to the respective forms of pregnancy hypertension, i.e. preeclampsia and gestational hypertension. Groups I and II included preeclamptic women, with (group I) or without (group II) de novo FSGS. Groups III and IV included biopsies of women with isolated gestational hypertension, appeared during the third trimester (group III) or earlier (group IV)...

Focal segmental glomerulosclerosis (FSGS) is observed in severe or atypical preeclamptic patients biopsied postpartum. To further define the structural characteristics that might be related to atypical clinical manifestations in this disorder, we analyzed the postpartum renal biopsies of eight preeclamptic patients with FSGS by morphometry and studied the structural-functional relationships. For comparison, three postpartum biopsies with primary FSGS and eight nonpregnant subjects with primary FSGS were also studied...

The renal effects of whole body irradiation in the perinatal period were studied in the dog. Ninety-three dogs received a single sublethal exposure in the range of 270 to 435 R in either late gestation (55 days postcoitus) or early postnatal life (2 days postpartum) and were sacrificed at 70 days, 2, or 4 years of age. Early renal lesions in 70-day-old irradiated dogs were characterized by arrested glomerular maturation and degeneration resulting in reduced functional renal mass. Mature glomeruli exhibited mesangial proliferation...

The influence of antecedent renal disease on pregnancy was studied retrospectively in 72 women with various renal diseases that had been proved by biopsy. Among 105 pregnancies studied, normal deliveries were observed in 74 (71%), abnormal deliveries with live infants in 14 (13%), fetal or neonatal deaths in 11 (10%), and spontaneous abortions in six (6%). The incidence of normal delivery, as well as that of live births, was the highest in the cases of membranous glomerulonephritis, but there was no obvious difference in the incidence among IgA nephropathy and non-IgA proliferative glomerulonephritis...

The morphologic alterations of true preeclampsia are well described and distinct. Using available criteria to define reversible pregnancy-induced nephropathy (PIN), the pathologist can offer the clinician information useful in predicting remote renal function and hypertension. True PIN is a usually completely reversible lesion in the nullipara and carries little risk of future hypertension. Nephrosclerotic vascular lesions, however, whether arteriolar, interlobular, or glomerular and resembling focal segmental glomerulosclerosis (FSGS), signify underlying hypertensive disease...

Eleven women were selected on the presence, in postpartum renal biopsies, of focal glomerulosclerosis (FGS) superimposed to glomerular lesions of typical pregnancy-induced nephropathy. Ten out of them presented with severe preeclampsia. The renal specimens were examined by light and/or electron and/or immunofluorescence microscopy. The present study gathered clinical and morphological data suggesting that FGS might develop during preeclampsia. In these renal biopsies with FGS and lesions of pregnancy-induced nephropathy a sparse detachment of podocyte was observed at a distance from the segmental lesions by electron microscopy...

Etiology and pathogenesis of focal and segmental glomerulosclerosis (FSGS) in patients with toxemia of pregnancy remain controversial. We examined 15 preeclamptic patients presenting with nephrotic syndrome. None of the patients had urinary abnormalities and hypertension before pregnancy. Clinically, proteinuria first developed during pregnancy and disappeared completely in all but one patient lost to follow-up after 1-30 months from delivery. Renal dysfunction, hypertension and edema rapidly resolved in the postpartum period...

Controversy has existed about the relative contributions of subendothelial "fibrinoid" deposits and endothelial cell swelling to the thickened glomerular capillary wall and reduced lumen in preeclampsia. A morphometric analysis of the ultrastructural changes in the glomerulus in preeclampsia showed that subendothelial fibrinoid deposits were a significant feature of biopsies during pregnancy, but were absent in many biopsies in the postpartum period. These deposits disappear progressively in the first week after delivery...

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