Collapsing Glomerulopathy during Pregnancy: A Case Series

Area of Science:

• Nephrology
• Obstetrics
• Pathology

Background:

• Preeclampsia is a major cause of pregnancy morbidity, linked to glomerular endotheliosis, fibrin deposition, and thrombotic microangiopathy.
• It presents with edema, proteinuria, and acute kidney injury, sometimes superimposed on pre-existing glomerular diseases.
• Biopsy studies reveal de novo glomerulopathy, including collapsing glomerulopathy, in preeclampsia cases.

Purpose of the Study:

• To report three cases of preeclampsia-associated collapsing focal and segmental glomerulosclerosis.
• To investigate the treatment and outcomes of these specific kidney conditions during pregnancy.

Main Methods:

• Case series reporting three pregnant patients in their third trimester with preeclampsia-associated collapsing focal and segmental glomerulosclerosis.
• Evaluation included assessment for secondary causes of nephrotic-range proteinuria.
• Treatment focused on antiproteinuric measures initiated post-delivery.

Main Results:

• Two patients were previously healthy; one had a history of chronic hypertension.
• All presented with nephrotic-range proteinuria without identifiable secondary causes.
• Antiproteinuric treatment post-delivery led to a complete response, negating the need for immunosuppressants.

Conclusions:

• Preeclampsia-associated collapsing glomerulopathy can resolve favorably after delivery.
• A subgroup of pregnant patients may avoid immunosuppression if preeclampsia is managed effectively.
• Early detection and appropriate management post-delivery can lead to positive maternal and fetal outcomes.