FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS) IN PREGNANCY: THE CASE OF A 27-YEAR-OLD WOMAN WITH NEPHROTIC SYNDROME AT 22 WEEKS OF GESTATION
Lucy Qiu-yun Wang1, Seethalakshmi Viswanathan2, Eddy Fischer1, Bhadran Bose1 1Nepean Hospital, Kingswood, NSW, Australia2Westmead Hospital, Westmead, NSW, Australia
Abstract
Background: Nephrotic syndrome (NS) in pregnancy has been associated with poor fetal outcomes, including preterm delivery, intrauterine growth restriction and neonatal mortality. Focal segmental glomerulosclerosis (FSGS) is one of the common causes of NS and can be primary or secondary. However, there are few case reports of FSGS diagnosed in the peripartum period and the approaches to management.
Case report: We report the case of a 27-year-old gravida 2 para 1 Caucasian woman diagnosed with NS at 22 weeks of gestation. Her serum creatinine was 46 umol/L, serum albumin 14g/L and 24-hour urinary protein 9.79g/day with no haematuria. Serology was negative for lupus, phospholipase A2 receptor antibody, hepatitis and HIV. Paraprotein screening was also negative. The patient declined a renal biopsy. Differential diagnoses at this stage included minimal change disease and FSGS. Six weeks after commencing empirical treatment with high-dose oral prednisolone, there was no response hence tacrolimus was initiated. The patient developed gestational diabetes and hypertension but had no intrapartum infections. Due to concern for maternal and fetal well-being, the decision was made to deliver via Caesarean section at 31 weeks, given worsening proteinuria (23.18g/24 hours). A live male infant was delivered weighing 1,625 g, with APGAR scores of 9, 9 and 9 at 1, 5 and 10 minutes, respectively. Renal biopsy at 4 weeks postpartum was consistent with FSGS. Unfortunately, the patient progressed to end-stage renal failure over the next 15 months.
Conclusion: This case highlights the strategies we utilised to manage a gravid patient presenting with nephrotic syndrome at 22 weeks’ gestation, where diagnosis could only be confirmed on renal biopsy in the postpartum period.
Biography
Dr Lucy Wang is a final year Advanced Trainee in Nephrology with a special interest in obstetric medicine. She obtained her Doctor of Medicine (MD) at the University of New South Wales (UNSW) in 2015, followed by internship, residency and Basic Physician Training at St George and Sutherland Hospitals. As part of Advanced Training she has worked at Westmead, Nepean and Blacktown Hospitals, gaining a wide variety of transplantation and general nephrology experience.
Dr Wang is a member of the RACP and ANZSN. Her research interests also include cognition, quality of life, and frailty in patients with end-stage renal failure.