Abstract
Background: The prevalence of asymptomatic renal scarring, such as a focal segmental glomerulosclerosis (FSGS), was suggested to be high in women who develop preeclampsia. FSGS is a risk factor for endstage renal disease. Objective: To document preeclamptic women with proteinuria that developed eight weeks prior to hypertension with confirmed FSGS postpartum. Case: A 20-year-old nulliparous Japanese woman with a negative dipstick test result at gestational week (GW) 18 exhibited proteinuria 1+ on dipstick test at GW 22. Proteinuria determined from the random urine protein to creatinine ratio (P/Cr, g/g) was increased from 3.7 at GW 26 to 4.6 and 8.9 at GW 28 and 30, respectively. She developed hypertension (142/66 mmHg) at GW 30. Due to increased edema, emergency cesarean section was performed at GW 33. She gave birth to an otherwise healthy female small-for-gestational-age infant, weighing 1290 g. Postpartum course was uneventful except for persisting proteinuria: P/Cr of 9.8 just before delivery decreased to 3.6 and 1.7 on postpartum weeks 9 and 17, respectively. Renal biopsy on postpartum week 13 revealed FSGS in this patient. Conclusion: Hidden FSGS may have manifested as preeclampsia in this patient. This case highlighted the need to determine the prevalence of asymptomatic FSGS among women who later develop preeclampsia.
Highlights
Proteinuria had been thought to be a late sign in the clinical course of preeclampsia [1], some women with preeclampsia develop proteinuria first and later develop hypertension [2,3]
This case highlighted the need to determine the prevalence of asymptomatic focal segmental glomerulosclerosis (FSGS) among women who later develop preeclampsia
Women with preeclampsia in whom proteinuria is severe enough to meet the criteria for nephrotic syndrome have a high prevalence of underlying renal disease, such as focal segmental glomerulosclerosis (FSGS) [4]
Summary
Proteinuria had been thought to be a late sign in the clinical course of preeclampsia [1], some women with preeclampsia develop proteinuria first and later develop hypertension [2,3]. As degree of proteinuria in pregnancy increases with advancing gestation [2], the amount of protein loss in the urine may be greater in women with early development of proteinuria. Women with preeclampsia in whom proteinuria is severe enough to meet the criteria for nephrotic syndrome have a high prevalence of underlying renal disease, such as focal segmental glomerulosclerosis (FSGS) [4]. We present a woman who developed proteinuria 8 weeks prior to the development of hypertension and had postpartum renal biopsy-proven FSGS to highlight the need to determine the prevalence of unrecognized FSGS in women who later develop preeclampsia.
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