Proteinuria in 3 sequential pregnancies following a fourth renal transplant

Pregnancy posttransplantation, particularly after kidney transplantation, is becoming common. It poses a challenge for transplant physicians, obstetricians and neonatologists due to the possible adverse maternal and foetal outcomes. The available experience on multiple pregnancies posttransplantation is limited. This case study reports 3 successful pregnancies - 5, 13 and 20 years after fourth renal transplantation resulting in vaginal deliveries at 37, 34 and 38 weeks - in a patient with reflux nephropathy. She developed hypertension, proteinuria and abnormal renal function during gestation with each pregnancy, all of which reversed after delivery. The reported case demonstrates successful foetal outcomes and reversible proteinuria, hypertension and allograft dysfunction possibly related to preeclampsia in the mother during her 3 successful pregnancies after a fourth renal transplant.