Focal segmental glomerulosclerosis after pregnancy complicated with preeclampsy and acute renal injury. Case report

  • Luis Arellán-Bravo Universidad Nacional Mayor de San Marcos, Lima, Perú
  • José Valencia-Rodríguez Hospital Nacional Dos de Mayo, Lima, Perú
  • Luis Sánchez-Pérez Hospital Nacional Dos de Mayo, Lima, Perú
  • Fernando Mayor-Balta Hospital Nacional Dos de Mayo, Lima, Perú
Keywords: focal and segmental glomerulosclerosis; preeclampsia; pregnancy; podocyturia; proteinuria; nephrotic syndrome

Abstract

We describe the case of a 35-year-old patient, who experienced preeclampsia and oliguric acute renal injury during her last pregnancy, requiring intervention by emergency cesarean section and dialysis support with a total of 16 hemodialysis sessions; she responded favorably.
Four months after discharge, she developed nephrotic syndrome, so she was hospitalized for better management and a thorough etiologic research. Support measures were taken with no need for renal replacement therapy; secondary lesions were ruled out and a renal biopsy was performed. The pathological study concluded that it was a focal segmental glomerulosclerosis, in its perihilar variant.
The patient responded favorably during her hospitalization and when discharged, she was summoned to continue management by external consultation. The appearance of nephrotic syndrome months after pregnancy may suggest the presence of an underlying glomerulopathy or de novo glomerulopathy.

References

1) Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet. 2008;371(9606):75-84.

2) Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy. 2001;20(1):IX-XIV.

3) Zhou Y, Damsky CH, Fisher SJ. Preeclampsia is associated with failure of human cytotrophoblasts to mimic a vascular adhesion phenotype. One cause of defective endovascular invasion in this syndrome? J Clin Invest. 1997;99(9):2152-64.

4) Kwiatkowski S, Kwiatkowska E, Rzepka R, Kurkiewicz V, Mikołajek-Bedner W, Torbè A. Development of a focal segmental glomerulosclerosis after pregnancy complicated by preeclampsia: case report and review of literature. J Matern Fetal Neonatal Med. 2016;29(10):1566-9.

5) Cornelis T, Odutayo A, Keunen J, Hladunewich M. The kidney in normal pregnancy and preeclampsia. Semin Nephrol. 2011;31(1):4-14.

6) Lafayette RA, Druzin M, Sibley R, Derby G, Malik T, Huie P, et al. Nature of glomerular dysfunction in pre-eclampsia. Kidney Int. 1998;54(4):1240-9.

7) Hennessy A, Makris A. Preeclamptic nephropathy. Nephrology (Carlton). 2011;16(2):134-43.

8) Henao DE, Mathieson PW, Saleem MA, Bueno JC, Cadavid A. A novel renal perspective of preeclampsia: a look from the podocyte. Nephrol Dial Transplant. 2007;22(5):1477.

9) Son GH, Kim JH, Hwang JH, Kim YH, Park YW, Kwon JY. Urinary excretion of nephrin in patients with severe preeclampsia. Urinary nephrin in preeclampsia. Hypertens Pregnancy. 2011;30(4):408-13.

10) Sugimoto H, Hamano Y, Charytan D, Cosgrove D, Kieran M, Sudhakar A, et al. Neutralization of circulating vascular endothelial growth factor (VEGF) by anti-VEGF antibodies and soluble VEGF receptor 1 (sFlt-1) induces proteinuria. J Biol Chem. 2003;278(15):12605-8.

11) Garovic VD, Wagner SJ, Petrovic LM, Gray CE, Hall P, Sugimoto H, et al. Glomerular expression of nephrin and synaptopodin, but not podocin, is decreased in kidney sections from women with preeclampsia. Nephrol Dial Transplant. 2007;22(4):1136-43.

12) Zhao S, Gu X, Groome LJ, Wang Y. Decreased nephrin and GLEPP-1, but increased VEGF, Flt-1, and nitrotyrosine, expressions in kidney tissue sections from women with preeclampsia. Reprod Sci. 2009;16(10):970-9.

13) Garovic VD, Wagner SJ, Turner ST, Rosenthal DW, Watson WJ, Brost BC, et al. Urinary podocyte excretion as a marker for preeclampsia. Am J Obstet Gynecol. 2007;196(4):320.e1-7.

14) Kriz W. The pathogenesis of 'classic' focal segmental glomerulosclerosis-lessons from rat models. Nephrol Dial Transplant. 2003;18(Suppl 6):vi39-44.

15) Wang IK, Muo CH, Chang YC, Liang CC, Chang CT, Lin SY, et al. Association between hypertensive disorders during pregnancy and end-stage renal disease: a population-based study. CMAJ. 2013;185(3):207-13.

16) Maharaj AS, Saint-Geniez M, Maldonado AE, D'Amore PA. Vascular endothelial growth factor localization in the adult. Am J Pathol. 2006;168(2):639-48.

17) Nochy D, Heudes D, Glotz D, Lemoine R, Gentric D, Bruneval P, et al. Preeclampsia associated focal and segmental glomerulosclerosis and glomerular hypertrophy: a morphometric analysis. Clin Nephrol. 1994;42(1):9-17.
Published
2020-08-27
How to Cite
1.
Arellán-Bravo L, Valencia-Rodríguez J, Sánchez-Pérez L, Mayor-Balta F. Focal segmental glomerulosclerosis after pregnancy complicated with preeclampsy and acute renal injury. Case report. Rev Nefrol Dial Traspl. [Internet]. 2020Aug.27 [cited 2024Dec.27];40(1):46-0. Available from: http://vps-1689312-x.dattaweb.com/index.php/rndt/article/view/508
Section
Case Report