title: Acute renal failure due to mesangial proliferative glomerulonephritis in a pregnant woman with primary Sjögren's syndrome.
abstract: The most common form of renal involvement in Sjögren's syndrome (SS) is tubulointerstitial nephritis. Renal dysfunction is usually mild and subclinical. Glomerulonephritis (GMN) is rare in patients with SS. We report a 28-year-old multigravida patient with primary Sjögren's syndrome (pSS) and associated manifestations, who presented with acute renal failure in the 20th week of her fifth pregnancy. The complaints and clinical findings, positive Schirmer's test, findings of dry eye on ophthalmologic examination, and the salivary gland biopsy were compatible with SS. The patient exhibited no other clinical or laboratory findings indicative of other collagenous disease and/or rheumatoid arthritis. She refused renal biopsy, hesitating for fear of fetal loss; thus, based on the clinical and laboratory findings indicating rapidly progressive GMN and vasculitis, prednisolone, plasmapheresis, and one dose of cyclophosphamide were administered during the pregnancy. Hemodialysis five times weekly was performed. At the 28th week of gestation, she underwent a cesarean section due to early rupture of membranes and fetal distress. A healthy male boy was delivered. The renal biopsy performed 2 weeks after labor revealed mesangial proliferative glomerulonephritis. After the fourth cyclophosphamide treatment, her urinary output increased and she was discharged from the hemodialysis program. She remains in follow-up at our outpatient clinic free of hemodialysis for 4 months. This is the first report of mesangial proliferative GMN requiring dialysis in a pregnant pSS patient that has featured good maternal and fetal outcomes.
authors.affiliation: Department of Nephrology, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Dadaloglu Mah 39/6 PK, 01250 Adana, Yuregir, Turkey. ulkuadam@yahoo.com
authors.forename: Fatma Ulku
authors.initials: FU
authors.lastname: Adam
authors.forename: Dilek
authors.initials: D
authors.lastname: Torun
authors.forename: Filiz
authors.initials: F
authors.lastname: Bolat
authors.forename: Aysegul
authors.initials: A
authors.lastname: Zumrutdal
authors.forename: Siren
authors.initials: S
authors.lastname: Sezer
authors.forename: Fatma Nurhan
authors.initials: FN
authors.lastname: Ozdemir
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D000328:Adult; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D006435:Renal Dialysis; D012859:Sjogren's Syndrome / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents