Collapsing Glomerulopathy during Pregnancy: A Case Series

Preeclampsia, a leading cause of morbidity during pregnancy, is associated with glomerular endotheliosis, fibrin deposition, and thrombotic microangiopathy and is characterized by edema, proteinuria, and acute kidney injury. Preeclampsia has been described on a background of glomerular disease membranous nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis, but biopsy studies have also described the de novo diagnosis of glomerulopathy as thrombotic microangiopathy, endotheliosis or collapsing glomerulopathy in the setting of preeclampsia.

We report 3 cases of preeclampsia-associated collapsing focal and segmental glomerulosclerosis in the third trimester of gestation, two of which were previously healthy and one with a history of chronic hypertension that presented with nephrotic-range proteinuria without secondary causes detected. It was decided to begin with antiproteinuric treatment after delivery, resulting in a complete response without the need for immunosuppressant drugs. The outcomes of these cases suggest that a favorable evolution is expected once preeclampsia had resolved and therefore the glomerular changes had been reversed.

A subgroup of pregnant patients can be managed without exposing the mother-child pair to adverse effects related to immunosuppression when preeclampsia is detected in the third trimester of gestation.