Successful pregnancy outcome in a patient with chronic glomerulonephritis and nephrotic-range proteinuria (Clinical observation)

Relevance. Pregnant women with chronic glomerulonephritis (CGN) are at high risk of placenta-associated and perinatal complications. We present a clinical case of successful pregancy outcome in a patient with CGN and nephrotic syndrome (NS), diagnosed in the first trimester, achieved through long-term maintenance combination therapy with heparin and acetylsalicylic acid.

Clinical observation. A 24-year-old woman experienced two episodes of macrohematuria within one and a half years prior pregnancy, but was not evaluated at that time. A tendency towards the development of nephrotic syndrome (NS) was identified in the first trimester of pregnancy; secondary causes of kidney disease was excluded. Primary CGN was diagnosed. Although termination of pregnancy was recommended, the patient declined. Dipyridamole and low-molecular-weight heparin were prescribed until 13 weeks gestation; from 13 week onward, dipyridamole was replaced with aspirin, and thrombodynamic parameters were monitored. The patient's condition remained stable and satisfactory throughout pregnancy: no edema, blood pressure up to 120/80 mm Hg, without antihypertensive therapy, daily proteinuria 1.5-1.7 g/L, erythrocyturia 10-20 per high-power field, blood creatinine 67-72 μmol/L, total protein 55-59 g/L, albumin 30-32 g/L. Markers of preeclampsia within the reference range. At 39 weeks of gestation, operative delivery was performed. A full-term female infant was born with Apgar scores of 8/9. In the postpartum period, NS recurred, and a kidney biopsy was performed revealing focal global and segmental glomerulosclerosis. Cyclosporine therapy was administered for one and a half years, resulting in complete remission of NS. Currently, there patient remains in stable remission of the NS and receives nephroprotective therapy with losartan 50 mg/day.

Conclusion. Close multidisciplinary monitoring and therapy with heparin and acetylsalicylic acid may increase the likelihood of a favorable pregnancy outcome in patients with CGN.

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