Renal Biopsy during Pregnancy-Permian Basin Experience

Background: Renal disease is extremely rare in pregnancy but presents a clinical dilemma when diagnosed. It is a poor prognostic marker for fetal and maternal health. There is limited data and recommendations to guide therapy in this subset of the population are lacking. We report our experience with 19 pregnant patients undergoing renal biopsies over a period of 5 years.

Methods: Retrospective analysis of all pregnant patients undergoing renal biopsy at our facilities from January 1, 2013, to April 30, 2018.

Findings: Nephrotic Syndrome (NS) was the most common indication for a renal biopsy during pregnancy accounting for 16/19 patients (84%). Glomerular disorder necessitating an immediate change in management was observed in 6/19 (31%). The median gestation was 32 weeks (range 20-40) with loss of two fetuses. Nondiabetic patients with NS were at a higher risk for preeclampsia (PE) than diabetic patients with NS (p<0.05). Three patients progressed to End-Stage Renal Disease (ESRD) needing dialysis; without any maternal deaths during the follow-up period.

Conclusion: Our series of pregnant patients undergoing renal biopsy demonstrates the variety of pathology in this group. An antepartum renal biopsy is safe in early pregnancy but should be considered only if there is a high likelihood to alter conventional therapy and aid progression of pregnancy to fetal viability. Close monitoring and early intervention is a key to improving feto-maternal outcomes particularly in non-diabetic patients with nephrotic syndrome.

Author(s): Asif A Ansari, Anton Kosov, Anand C Reddy, Narothama Reddy Aeddula, Ajay K Vaikuntam, Leela S Pillarisetty, Jawaher Ansari, Keerthi Raja and Joseph Bottalico

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