#1851 Pregnancy outcomes in women with glomerular disease: Mansoura experience
Authors: Shemies Rasha Samir , Zayed Karem N , Khreba Nora , Younis Dalia , Mosbah Alaa , Piccoli Giorgina , Elnagar Sherouk 
Published: May 2024

Abstract

Background and Aims
Pregnancy is a “stress test” for the kidney, and may initiate, aggravate, or unmask a kidney disease. Pregnancy in women with glomerular disease remains challenging. Glomerular disease increases the risks of adverse pregnancy outcomes especially in case of reduced eGFR, proteinuria or uncontrolled hypertension. The heterogeneity of the diseases, severity and settings does not allow making precise outcome predictions. Few data are available from African countries. Aim of this study is to review the outcomes of 43 pregnant women with biopsy-proven glomerulonephritis followed-up in 2020-2022, in a new unit for obstetric nephrology set up in Mansoura, Egypt.

Method
We reviewed archived paper and electronic records for history, clinical data, and laboratory investigations as well as immunologic profile of all women with glomerular diseases followed up since the start of our activity. Outcomes included timing and mode of delivery, maternal and foetal mortality, neonatal ICU admission, low birth weight (&lt;2.5 kg), and presence of congenital anomalies. In the postpartum period, data on maternal renal function was also analysed. Renal function impairment was defined as ≥150% increase in postpartum serum creatinine compared to antenatal baseline values.

Results
43 patients were included. Lupus nephritis accounted for 52.4%, minimal change disease 16.7%, focal segmental glomerulosclerosis 14.3%, membranous nephropathy 7.1%, thrombotic microangiopathy, membranoproliferative, crescentic, and focal proliferative GN accounted for 2.4% (one case) each. Patients were referred in the 22 (4-37) weeks of pregnancy from regional urban and rural obstetric services. At referral 27 (62.8%) patients were in stage 1, 8 (18.6%) in stage 2, 7 (16.3%) in stage 3 and 1 (2.3%) in stages 4-5 CKD. Proteinuria at referral was 1000 (16-34.500 mg/d). Twenty-two (51.2%) women were hypertensive at referral. Obstetric outcomes were assessed in 36 pregnancies, which resulted in 30 live birth (78.9%); with one postnatal mortality, no miscarriage (&lt;24 gestational weeks), in 4 (10.5%) intrauterine deaths and in 4 (10.5%) induced abortion. Of the living born babies, 2 (6.7%) were extremely preterm (&lt;28 weeks), 8 (26.7%) early preterm (28-34 weeks) and 8 (26.7%) late preterm (34-37 weeks).
Renal progression was assessed in 33 cases, occurring in 0% in patients with MCD, MN and membranoproliferative, 3 (17.6%) in LN, 2 (50%) FSGS, 100% of patients with focal proliferative, TMA and crescentic GN (one case for each). Out of 3 mothers who were in CKD stages 3b-5 at referral, one started dialysis.

Conclusion
Glomerulonephritis in pregnancy is probably referred late in our setting, and lupus nephropathy was the most frequent diagnosis. Preterm delivery and low birth weight are frequent in this population and the risk of maternal kidney function impairment is confirmed as higher in lupus nephropathy and when baseline kidney function impairment, proteinuria and hypertension are present.