Kidney biopsies in multiparous patients with vascular renal disease in pregnancy

Abstract

Renal biopsies were obtained at delivery from 66 multiparas who had toxemia in one or more pregnancies and from 10 multiparas whose pregnancies were uncomplicated by toxemia. There were no renal abnormalities in this latter group.Ten individuals who had had previous pre-eclampsia and eclampsia, and 24 individuals in whom the diagnosis of hypertensive disease was made exhibited normal histologic findings. Fourteen individuals presented findings characteristic of nephrosclerosis. Six had chronic renal disease of uncertain etiology. Four had chronic pyelonephritis in the absence of clinical evidence of the disease, and 2 individuals in this group had clinically undiagnosed bilateral polycystic kidneys as an additional finding. Lupus nephritis was present in 2 patients.The so-called “reversible toxemic lesion” was present in a moderate or severe form in 18 per cent of these patients, and the status of this lesion was regarded as uncertain.Many individuals had considerable renal disease with little clinical evidence of it, while others had a clinically severe toxemia of pregnancy in the absence of demonstrable renal disease.It was impossible to predict the presence of organic renal changes or the magnitude of the renal lesion on the basis of the fundoscopic findings.It was concluded that pre-eclampsia and eclampsia did not result in permanent renal damage and evidence was presented to support the contention that an increase in hypertension, proteinuria, and edema, or the initial occurrence of these manifestations of toxemia during the last 14 weeks of gestation in an individual with renal-vascular disease was the result of an exacerbation of this disease rather than the result of superimposed pre-eclampsia.