Management Challenges of a Pregnant Woman With Undiagnosed Nephrotic Syndrome: Experience From Saudi Arabia

This case report discusses the overall care of a female patient with nephrotic syndrome secondary to non-pre-eclampsia-related hypertension in pregnancy, emphasizing the challenges and multidisciplinary treatment needed for desired results. The case presented here involves a 32-year-old pregnant woman with a history of unexplained primary infertility who conceived through in vitro fertilization (IVF). At 26 weeks and three days of gestation, she presented with symptoms suggestive of nephrotic syndrome, including lower limb swelling, facial puffiness, oliguria, and dark-colored urine. In her history, she had gestational hypertension and was treated with methyldopa. The first presentation and later management of this patient demonstrate the complexities involved in the management of pregnancy complicated by nephrotic syndrome. As part of the diagnostic workup, this patient had a detailed clinical assessment together with laboratory and imaging investigations, which substantiated the diagnosis of nephrotic syndrome. Management of the patient was made complicated by poorly controlled hypertension, the presence of proteinuria, and active inflammation, necessitating combined care by a multidisciplinary team. The management plan, performed at King Abdulaziz Medical City in Riyadh, included close monitoring of maternal and fetal parameters, pharmacological intervention for hypertension and infection, and supportive care to address the symptoms of nephrotic syndrome. This case highlights the complex interplay between nephrotic syndrome and pregnancy, emphasizing the critical need for early diagnosis, multidisciplinary management, and individualized therapeutic strategies. The patient's favorable outcome, achieved through timely intervention (including renal biopsy and emergency cesarean delivery), demonstrates that, even in high-risk scenarios, a coordinated approach can optimize both maternal and fetal outcomes.