GLOMERULONEPHRITIS IN PREGNANCY

Course overview

PREGNANCY TRIGGERS NUMEROUS PHYSIOLOGICAL CHANGES, INCLUDING VOLUME EXPANSION, VASODILATION, AND HORMONAL SHIFTS THAT SUPPORT RENAL ADAPTATION. PATIENTS MAY EITHER DEVELOP DE NOVO GLOMERULONEPHRITIS DURING PREGNANCY, OR THEY MAY HAVE A HISTORY OF THE CONDITION BEFORE CONCEPTION, WHICH COMPLICATES PREGNANCY MANAGEMENT. GLOMERULONEPHRITIS IN PREGNANCY CAN MANIFEST AS ACUTE KIDNEY INJURY OR EXACERBATE CHRONIC KIDNEY DISEASE, AFFECTING BOTH MATERNAL AND FETAL OUTCOMES. FOCAL SEGMENTAL GLOMERULOSCLEROSIS IS THE MOST COMMON GLOMERULONEPHRITIS IN PREGNANCY, FOLLOWED BY IGA NEPHROPATHY, ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES (ANCA)–RELATED GLOMERULONEPHRITIS, AND LUPUS NEPHRITIS.MANAGING GLOMERULONEPHRITIS IN PREGNANCY PRESENTS UNIQUE CHALLENGES DUE TO ALTERED KIDNEY PHYSIOLOGY, LIMITED SAFETY DATA ON IMMUNOSUPPRESSANTS, AND THE NEED FOR CAREFUL CONSIDERATION OF THE PHYSIOLOGICAL CHANGES ASSOCIATED WITH PREGNANCY, WHICH MAY REQUIRE MODIFICATIONS TO DIAGNOSTIC AND TREATMENT STRATEGIES. BOTH DIAGNOSTIC TESTING AND TREATMENT OPTIONS MUST BE ADAPTED TO ACCOMMODATE THESE CHANGES. EVALUATION INCLUDES TESTING FOR ANTINUCLEAR ANTIBODIES (ANA), ANCA, COMPLEMENT LEVELS, ANTI-DSDNA, ANTI-PHOSPHOLIPID, AND ANTI-PLA2R ANTIBODIES, ESPECIALLY IN CASES OF NEW-ONSET PROTEINURIA. KIDNEY BIOPSY IS RECOMMENDED IF DISEASE PROGRESSION IS SUSPECTED OR IF BIOPSY RESULTS WILL INFLUENCE MANAGEMENT. ROBUST DATA ON GLOMERULONEPHRITIS IN PREGNANCY ARE LIMITED. THIS ACTIVITY HIGHLIGHTS THE KIDNEY-RELATED PATHOPHYSIOLOGICAL ALTERATIONS DURING PREGNANCY AND FOCUSES ON EVALUATING AND MANAGING GLOMERULONEPHRITIS IN THIS CONTEXT.