Pre-eclampsia is known to be the commonest cause of nephrotic syndrome in pregnancy. It can be difficult to distinguish from underlying renal pathology.
This retrospective cohort study, spanning 11 years, reviewed pregnancies complicated by nephrotic proteinuria in a large maternity hospital (approx 8000 births/year). The aims were to evaluate the adequacy of booking assessments, renal, maternal and foetal outcomes and adequacy of follow up.
Only renal outcomes are presented here.
Two hundred and sixty four pregnancies in 262 women were reviewed, 11 were under renal follow-up at time of booking and 5 had, had prior renal biopsy. Booking blood pressure was recorded in 222 (84%) and urinalysis in 175 (67%), of whom 15 (9%) had significant dipstick proteinuria (>1+).
Only 104 (57%) women had urine tested in centre postnatally, 47(50%) of these women had continued proteinuria at the time of last follow up, >6 months in 34(72%), mean 1418+118days. Proteinuria was heaviest during pregnancy in all patients. One woman was biopsied during pregnancy and 8 were biopsied postpartum. Significant renal disease was newly diagnosed in 9(10%), of these, only 3 had significant proteinuria at booking. Follow-up data with regard to blood pressure was complete in only 69 women, 67 (97%) became normotensive during the follow up period.
Although pre-eclampsia was the commonest cause of nephrotic proteinuria this study highlights the importance of careful follow-up as a significant proportion have underlying renal disease.
Proteinuria at booking may be a clue to underlying renal disease but isn't always present.
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