Abstract
There is little information about pregnancy outcomes in patients with active membranous nephropathy (MN), especially those with circulating autoantibodies to M-type phospholipase A2 receptor (PLA2R), the major autoantigen in primary MN. Membranous glomerulonephritis (MGN) represents an immunologically mediated disease characterized by deposition of immune complexes in the glomerular subepithelial space, frequently associated with circulating M-type phospholipase A2 receptor. Nephrotic syndrome (massive proteinuria and hypoalbuminemia) at diagnosis predicts poor prognosis. Pregnancy with active MGN is high risk for foetal loss, intrauterine growth restriction, and pre-eclampsia, and may worsen maternal renal function, especially with the presence of antiphospholipid antibody syndrome (APLA). We report a 23-year-old gravida in her first pregnancy, suffering from MGN and severe nephrotic syndrome, complicated by APLA syndrome. The patient was treated with enoxaparin, aspirin azathioprine, and Prednisone for a short time, in addition to furosemide and albumin intravenously. She was delivered at 30 weeks due to deteriorating maternal and foetal conditions. A successful neonatal and maternal outcome was achieved in this case. The patient's history revealed thrombocytopenia and APLA syndrome and continues to be treated chronically with enoxaparin. Kidney biopsy performed after delivery showed membranous MGN stage II-III. Herein, we present a case of successful pregnancy and foetal outcome in a young woman with APLA syndrome and MN. Keywords: Membranous GN, Nephrotic Syndrome, Anti-Phospholipid Antibodies.
Highlights
Pregnant patients with autoimmune disease may deliver newborns with a spectrum of clinical manifestations due to the transplacental passage of circulating autoantibodies
Membranous glomerulonephritis (MGN) represents an immunologically mediated disease characterized by deposition of immune complexes in the glomerular subepithelial space, frequently associated with circulating M-type phospholipase A2 receptor
Membranous glomerulonephritis (MGN) presents one of the most common forms of nephrotic syndrome in adults, an autoimmune disease mainly caused by autoantibodies against the recently discovered podocyte antigens, the M-type phospholipase A2 receptor 1 (PLA2R), and thrombospondin type 1 domain-containing 7A (THSD7A) [1]
Summary
Pregnant patients with autoimmune disease may deliver newborns with a spectrum of clinical manifestations due to the transplacental passage of circulating autoantibodies. Our patient was in good general condition, without dyspnoea Her body temperature was 36.0°C, her pulse rate was 74 beats/minute, and her blood pressure was 135/85 mmHg. The findings on physical examination were normal, except for severe pitting oedema in the lower extremities (+3) up to the height of her knees, arms, and eyelids. The patient developed pre-eclampsia manifested by blood pressure 150/100 mmHg in addition to headache She was rehospitalized and treated with intravenous furosemide and albumin, in addition to enoxaparin and aspirin. Because of mild proteinuria, a closed renal biopsy was performed and revealed stage II-III membranous nephropathy (MGN) with tubule-reticular inclusions in the endothelial cells.
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