#3512 GLOMERULOPATHIES DURING PREGNANCY: A TEN-YEAR SINGLE CENTER EXPERIENCE
Authors: Nogueira Estela , Afonso Rita , Godinho Iolanda , Centeno Mónica , Pinto Luísa , Lopes José António 
Published: June 2023

Abstract

Background and Aims
Literature regarding pregnancy management and outcomes in women with glomerulopathies is still sparse. Specific guidelines for each glomerulopathy are still lacking which impairs a more homogeneous approach. The authors describe the multidisciplinary approach and the outcomes of pregnant women with primary and genetic glomerulopathies.

Method
Retrospective observational study in which the authors reviewed maternal, obstetric and perinatal outcomes in pregnant women with primary and genetic glomerulopathies surveilled at our nephro-obstetric clinic from 2011 to 2021.

Results
We evaluated 23 gestations in 20 patients (two pregnancies still ongoing). Mean age was 32.4±5.4 years (18-41), 17 women were caucasian, 3 black African, 10/23 nulliparous and 5/20 had chronic hypertension. Mean baseline SCr was 0.8±0.3mg/dl (0.5-1.8) and proteinuria was 1360±2199.6 mg/day (150-8615), with 13/6/2 patients being on CKD stage 1/2/3, before pregnancy, respectively (unknown in 2 patients). The most frequent CKD etiologies were IgA nephropathy (6/20), Focal Segmental Glomerulosclerosis (FSGS; 3/20) and Membranous nephropathy (2/20). Exposure to teratogenic therapy during the 1st trimester occurred in 5/23 gestations with a mean exposure of 7.0±3.6 weeks. De novo proteinuria and worsening proteinuria occurred in 3/23 and 16/23 patients, respectively, with full blown nephrotic syndrome in 4/23 patients. Renal function deteriorated in one patient (CKD G3). Kidney biopsy was performed in 1/20 and 3/20 patients during and post pregnancy, revealing IgA Nephropathy (2/20, 1 with superimposed FSGS), C3 glomerulonephritis (1/20) and FSGS (1/20). Genetic diagnosis was done during/post pregnancy in 3/1 patients. Aspirin and LMWH were started in 17/23 and 4/23 gestations, respectively. Immunosuppression consisted of cyclosporin or tacrolimus with or without low dose prednisolone in 6/23 patients with partial and complete remission in all patients. De novo and worsening hypertension occurred in 2/23 and 3/23 gestations, during the 3rd trimester. Preeclampsia developed in 1 patient at 32 weeks. Fetus malformation (trisomy 21) and severe nephrotic syndrome led to pregnancy termination during the 1st trimester in two pregnancies. Cesarean delivery was performed in 5 gestations mainly due to pelvic position. Mean gestation time was 38.9±2 weeks. There was one preterm delivery due to preeclampsia. Mean birth weight was 3076.6±630.7 mg (1500-3850), with 3 newborns having low birth weight (&lt;2500g). Apgar scores at 1/5/10 minutes were 9/10/10, respectively. Neonatal intensive care was needed in 1 newborn.

Conclusion
In our series, glomerulopathies with proteinuria or nephrotic syndrome were not associated with poor renal and perinatal outcome, with only one patient developing PE and renal function deterioration, probably associated to with CKD stage 3. In patients with nephrotic syndrome, immunosuppression with calcineurin inhibitor and low dose prednisone was associated with complete or partial remission in all patients.