P0294WHEN DO WE HAVE TO SUSPECT THAT A PREECLAMPSIA MASKS A GLOMERULOPATHY?
Authors: Galceran Herrera Isabel , Ribas Closa Andrés , Vázquez González Susana , Sans Atxer Laia , Barrios Clara , Outón Sara , S. Ochoa Adriana , Pascual Santos Julio , Rodriguez Eva 
Published: June 2020

Abstract

Background and Aims
Between the 2-8% of pregnancies suffer preeclampsia (PE). In the literature, there have been reported cases of glomerulopathy debuted by pregnancy (GDP) which are initially missdiagnosed as PE. These cases are unusual and not well-defined. We aimed to evaluate clinical and analytical factors that allow us to suspect that a PE masks a GDP.

Method
Retrospective study that included pregnant patients with a postpartum histological diagnosis of glomerulopathy who had been missdiagnosed as PE during pregnancy. We compared them with patients who suffered PE with full recovery after childbirth. We evaluate demographic variables of pregnant women and newborns, clinical variables related to pregnancy and childbirth, blood pressure (BP) and analytical variables before pregnancy and postpartum (serum creatinine (sCrea), estimated glomerular filtration rate by CKD-EPI equation (eGFR), serum uric acid (sUA), ratio of urine protein to creatinine (UPCR)).

Results
Thirty patients were included in the study ,10 patients with a postpartum histological diagnosis of glomerulopathy who had been diagnosed as PE during the pregnancy and 20 patients with a diagnosis of PE without GDP, baseline characteristics are described in attached table. Glomerulopathy was diagnosis through renal biopsy, main indication of renal biopsy was the persistence of proteinuria and/or sediment abnormalities after 4 months of childbirth. The diagnoses were: IgA nephropathy (3, 33.3%), focal and segmental hyalinosis (2, 22.2%), X-linked Alport syndrome (2, 22.2%), diabetic nephropathy (1, 11.1%), lupus nephritis (1, 11.1%) and chronic interstitial nephropathy (1, 11.1%).
Pregnant women with GDP showed higher prevalence of smoking habit and major value of sCrea and sUA (figure). Regarding to pregnancy factors, patients with GDP had significant higher prevalence of primiparous gestation (100% vs 40%, p=0.002), twin gestation (20% vs 0%, p=0.03), premature newborn (50% vs 15%, p=0.01) and higher weight gain during pregnancy (13.9±5.8 vs 9.5±3.6 kg, p=0.01). Furthermore, in the postpartum data we objected a higher value of systolic/diastolic BP (145.6±10.3 / 89.4±12.1 vs 128.5±10.0 / 80.0±6.3 mmHg, p&lt;0.05), sCrea (0.83±0.3 vs 0.54±0.2 mg/dl, p=0.02), sUA (5.8±1.3 vs 3.4±0.8 mg/dl, p&lt;0.001) and UPCR (3046 [613-4179] vs 802 [281-948] mg/g, p=0.05) in patient with NPD.

Conclusion
Our results suggest that clinical and analytical variables in pregnancy and post-partum allow clinicians suspect a glomerulopathy in the setting of PE. Patients diagnosed as PE who develop GDP had higher prevalence of smoking habit, primiparous gestation, twin gestation and premature newborns. In addition, they also have higher weight gain during pregnancy, worse renal function and major sUA before pregnancy and after childbirth, and major UPCR and BP after childbirth; compared with patients with PE and full recovery after childbirth.