The role of renal biopsy in women with kidney disease identified in pregnancy.
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 m(2) [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 m(2). 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.
Day
Clara
C
Dept of Nephrology, University Hospital, Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TH, UK.
Hewins
Peter
P
Hildebrand
Sarah
S
Sheikh
Lumaan
L
Taylor
Gabrielle
G
Kilby
Mark
M
Lipkin
Graham
G
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000473:pathology*; D011181:Postnatal Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D011295:Prenatal Care