Renal disease in pregnancy. Three controversial areas: mesangial IgA nephropathy, focal glomerular sclerosis (focal and segmental hyalinosis and sclerosis), and reflux nephropathy.
Whether gestation has adverse effects on the course of renal disease is controversial. Three diseases regarding which conflicting opinions are especially noteworthy are IgA nephropathy, focal and segmental hyalinosis and sclerosis, and reflux nephropathy. We analyzed 102 pregnancies in 65 women with IgA nephropathy, noting hypertension in 63% of the gestations (severe in 18%), decreases in renal function in 22%, and biopsy evidence demonstrating a significantly greater amount of glomerular proliferation and crescents as well as focal and segmental hyalinosis and sclerosis when the renal histology from women who were pregnant and those who had never conceived were compared. Our experience with glomerular sclerosis is limited to 28 gestations in 15 patients, but the clinical findings resemble those of women with IgA nephropathy who conceived. Finally, we analyzed 227 pregnancies in 95 women with normal renal function and reflux nephropathy comparing results to 118 gestations in 42 patients with evidence of dysfunction (serum creatinine SCr greater than 1.25 mg/dL). Women with preserved function had good outcomes in general, whereas hypertension (36%) and an accelerated decline in function (8%) were observed in the groups that had moderate renal insufficiency in the initial stage of pregnancy. Increased proteinuria was the best predictor of progression of reflux nephropathy in both groups.
D001706:Biopsy; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis*; D005922:Glomerulonephritis, IGA / Q000175:diagnosis* / Q000503:physiopathology; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000503:physiopathology; D011704:Pyelonephritis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology