UTILITY OF RENAL BIOPSY IN PREGNANCY: A CASE REPORT
Dr Prudence Gregory1, Dr Ashley Irish1, Dr Jessica Phillips1
1Fiona Stanley Hospital, Murdoch, Australia
Background: Renal biopsy is a key investigation in the diagnosis and management of intrinsic renal disease. It is rarely performed during pregnancy due to concerns about increased complication rates. However, for a select group of pregnant women, biopsy can provide essential information to guide management and allow continuation of pregnancy.
Case Report: A 32-year-old nulliparous woman presented with lower limb oedema and dyspnoea at 21 weeks gestation. She had undergone in vitro fertilisation (IVF) for primary infertility but had no other significant medical history. At the time of presentation, she was hypertensive. Investigations revealed anaemia with evidence of haemolysis, thrombocytopenia, mild renal impairment and haemoproteinuria.
Given the combination of new onset hypertension, renal impairment and haemolysis after 20 weeks gestation, a pre-eclampsia spectrum disorder was suspected. However, due to the atypical clinical features of active urinary sediment, elevated inflammatory markers, abnormal complement levels and positive ANA, she underwent renal biopsy at 22 weeks gestation.
Biopsy confirmed class IV diffuse lupus nephritis. She was commenced on hydroxychloroquine, prednisolone and azathioprine with improvement in clinical and biochemical markers of lupus activity.
Her pregnancy was unremarkable until 35 weeks gestation when she developed labial shingles. Deterioration in renal function with evidence of haemolysis and rising inflammatory markers was noted at 36 weeks. A healthy 2.86kg baby was delivered by caesarean section at 36+6.
Conclusions: Correct diagnosis and appropriate subsequent management of renal disease is crucial for pregnant women and their fetus. Utilisation of renal biopsy should be considered by the treating physicians during pregnancy if the findings will significantly alter management choices, particularly in women with a sudden decline in eGFR, active urinary sediment or nephrotic range proteinuria.
Biography:
Prudence is a second year advanced trainee in nephrology who is currently based at Fiona Stanley Hospital in Perth. After graduating from the University of Notre Dame, she completed Basic Physician Training at Sir Charles Gairdner Hospital. She has keen interest in renal biopsy and glomerulonephritis.