Increased antiangiogenetic factors in severe proteinuria without hypertension in pregnancy: is kidney biopsy necessary?

CEN Case Reports
Takako OhmaruMitsuaki Suzuki

Abstract

Acute onset of severe proteinuria during pregnancy obliges physicians to clinically discriminate between gestational proteinuria (GP) and new onset of nephritis. A multiparous woman developed severe proteinuria (5.8 g/day) without hypertension at 32 weeks of gestation. We measured the maternal level of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng), which were extremely high (41.3 and 54.8 ng/ml, respectively), leading us to consider this condition as GP rather than acute onset of nephritis. Thus, we did not perform a kidney biopsy and did not administer a steroid agent. Non-reassuring fetal status required emergency Cesarean section at 33 weeks. Proteinuria decreased to 0.36 g/day at 12 weeks after delivery, and finally disappeared 26 weeks postpartum. Measurement of sFlt-1 and sEng in a pregnant woman with severe proteinuria without hypertension may assist in differential diagnosis of GP from acute onset of nephritis, and thus help to decide whether to perform kidney biopsy during pregnancy.

References

Feb 7, 2004·The New England Journal of Medicine·Richard J LevineS Ananth Karumanchi
Feb 7, 2006·American Journal of Obstetrics and Gynecology·Hisashi MasuyamaYuji Hiramatrsu
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Apr 27, 2007·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Akihide OhkuchiMitsuaki Suzuki
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Oct 31, 2008·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Chikako HirashimaMitsuaki Suzuki
Jan 24, 2009·Hypertension in Pregnancy : Official Journal of the International Society for the Study of Hypertension in Pregnancy·Akihide OhkuchiMitsuaki Suzuki
Nov 5, 2010·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Chikako HirashimaMitsuaki Suzuki
Jan 17, 2013·BJOG : an International Journal of Obstetrics and Gynaecology·G B PiccoliT Todros
Jan 22, 2013·Wiener klinische Wochenschrift·Selman UnverdiMurat Duranay

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