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Published on: June 8, 2022
Pregnancy in women with nephrotic-range proteinuria: A retrospective cohort study
Shuli Svetitsky1, Liz Lightstone2, Kate Wiles3
1Imperial College Healthcare NHS Trust Renal and Transplant Centre, Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland.
Background:
Obstetric and kidney outcomes following detection of nephrotic-range proteinuria in early pregnancy have not been well described.
Methods:
A retrospective cohort study of chronic kidney disease (CKD) in pregnancy between 2008 and 2018. Outcomes in those with nephrotic-range proteinuria before 20 weeks' gestation were compared to those without nephrotic-range proteinuria.
Results:
The study included 37 women with nephrotic-range proteinuria and 62 women without. Pre-pregnancy estimated glomerular filtration rate (eGFR) was similar. Nephrotic-range proteinuria was associated with higher rates of preterm (odds ratio [OR] 1.77, 95% confidence interval [CI]: 1.07-2.92) and early preterm delivery (OR 2.63, 95% CI: 1.12-6.2), and with a requirement for renal replacement therapy at 3 years post-partum (OR 10.72, 95% CI: 2.58-44.47). Tubulointerstitial scarring on kidney biopsy was associated with early preterm delivery and progression to advanced CKD, independent of pre-pregnancy eGFR.
Conclusion:
Compared to CKD without nephrotic-range proteinuria, nephrotic-range proteinuria early in pregnancy is associated with higher rates of pre-term delivery and progression to advanced CKD.
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