OJOG  Vol.3 No.9 , November 2013
Hidden renal disease in a female patient with long-lasting isolated gestational proteinuria followed by hypertension
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.


Cite this paper
Kawabata, K. , Akaishi, R. , Nozaki, A. , Sato, O. , Hanatani, K. and Minakami, H. (2013) Hidden renal disease in a female patient with long-lasting isolated gestational proteinuria followed by hypertension. Open Journal of Obstetrics and Gynecology, 3, 680-682. doi: 10.4236/ojog.2013.39124.
References
[1]   Chesley, L.C. (1985) Diagnosis of preeclampsia. Obstetrics & Gynecology, 65, 423.

[2]   Morikawa, M., Yamada, T., Yamada, T., Cho, K., Yamada, H., Sakuragi, N., et al. (2008) Pregnancy outcome of women who developed proteinuria in the absence of hypertension. Journal of Perinatal Medicine, 36, 419-424. http://dx.doi.org/10.1515/JPM.2008.062

[3]   Yamada, T., Yamada, T., Morikawa, M., Takeda, M., Nishida, R., Akaishi, R. and Minakami, H. (2011) Isolated proteinuria as an initial sign of severe preeclampsia. Open Journal of Obstetrics and Gynecology, 1, 13-16. http://dx.doi.org/10.4236/ojog.2011.12003

[4]   Nishimoto, K., Shiiki, H., Nishino, T., Kimura, T., Sasaki, Y., Yamasaki, M., et al. (1999) Glomerular hypertrophy in preeclamptic patients with focal segmental glomerulosclerosis. A morphometric analysis. Clinical Nephrology, 51, 209-219.

[5]   Ozlü, T., Alcelik, A., Calisβkan, B., Donmez, M.E. (2012) Preeclampsia: Is it because of the asymptomatic, unrecognized renal scars caused by urinary tract infections in childhood that become symptomatic with pregnancy? Medical Hypotheses, 79, 653-655. http://dx.doi.org/10.1016/j.mehy. 2012.08.002

[6]   Morita, M., Yoshiara, S., White, R.H. and Raafat, F. (1990) The glomerular changes in children with reflux nephropathy. The Journal of Pathology, 162, 245-253. http://dx.doi.org/10.1002/path. 1711620311

[7]   McGladdery, S.L., Aparicio, S., Verrier-Jones, K., Roberts, R. and Sacks, S.H. (1992) Outcome of pregnancy in an Oxford-Cardiff cohort of women with previous bacteriuria. Quarterly Journal of Medicine, 83, 533-539.

[8]   Nakamura, T., Ushiyama, C., Suzuki, S., Hara, M., Shimada, N., Ebihara, I., et al. (2000) The urinary podocyte as a marker for the differential diagnosis of idiopathic focal glomerulosclerosis and minimal-change nephrotic syndrome. American Journal of Nephrology, 20, 175-179. http://dx.doi.org/10. 1159/000013580

[9]   Craici, I.M., Wagner, S.J., Kent, R., Bailey, K.R., Fitz-Gibbon, P.D., Wood-Wentz, C.M., et al. (2013) Podocyturia predates proteinuria and clinical features of preeclampsia: Longitudinal prospective study. Hypertension, 61, 1289-1296. http://dx.doi.org/10.1161/HYPERTENSIONAHA.113.01115

[10]   Unverdi, S., Ceri, M., Unverdi, H., Yilmaz, R., Akcay, A. and Duranay, M. (2013) Postpartum persistent proteinuria after preeclampsia: A single-center experience. Wiener Klinische Wochenschrift, 125, 91-95. http://dx.doi.org/10.1007/s00508-013-0320-8

 
 
Top