POS-165 RENAL OUTCOMES IN PATIENTS PRESENTING TO A RENAL SERVICE WITH PROTEINURIA DURING PREGNANCY WHO WERE SUBSEQUENTLY BIOPSIED: 10 YEAR EXPERIENCE

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We reviewed retrospectively all women whose initial referral to our renal service was with proteinuria during pregnancy and who went on to have a renal biopsy in the decade to January 2020. We describe the renal histology findings and renal outcomes. Case records were reviewed of women referred to our renal antenatal service in the 10 years to 1st January 2020 with unexplained proteinuria and subsequently biopsied. Only women were included where this was their first presentation to a nephrology service. The patients were reviewed by a single consultant nephrologist (MT) and managed jointly during pregnancy with a consultant obstetrician. All the renal biopsies and renal follow up were carried out by a single centre renal service. 11 women had a first renal review during pregnancy - 5 were South Asian, 5 Caucasian and 1 Afro-Carribean. The median age (range) 28 (16-36) years. Two out of 4 patients presenting before 16 weeks gestation were biopsied during pregnancy*, the remaining 9 had a renal biopsy a median of 10 (2-90) months after their antenatal presentation. Tabled 1Protein: creatinine ratio mg/mmolSerum Creatinine umol/lGestation(weeks)Time from presentation to biopsy (months)Renal histologyRenal outcome117173990Crescentic GN - ANCA positive (MPO)CKD 42144101289IgARRT3736451810FSGSCKD 14283592913IgACKD 35427633165IgACKD 367543715*<1Membranous GNRecovery71196589*<1Minimal ChangeRecovery8452741519Diabetic NephropathyRRT923650296IgACKD 51011691342IgACKD 21132**502524IgACKD 1∗∗albumin: creatinine ratio mg / mmol at 14 weeks gestation Open table in a new tab ∗∗albumin: creatinine ratio mg / mmol at 14 weeks gestation Two patients with stable renal disease for more than 5 years were biopsied because of deteriorating renal function with the second also having positive ANCA (MPO) serology, 65 and 90 months post antenatal presentation. Although all except one patient had a normal antenatal serum creatinine - after a median of 75 (11-106) months follow up 2 patients were receiving renal replacement therapy (RRT), 6 had CKD and 2 had made a full renal recovery (see Table). The commonest histological diagnosis was IgA nephropathy which was present in 6 patients (55%) and 5 of these had evidence of progressive CKD. IgA is the commonest primary glomerulonephritis with a peak incidence in the 2nd and 3rd decades1 and is common in women receiving obstetric care2. Data on long term renal outcomes of women with primary renal disease are sparse. In this centre, for women presenting antenatally with the initial signs of renal disease, IgA nephropathy was the most frequent histological diagnosis and the renal outcomes were variable.