Preeclampsia can be an insult predisposing to focal segmental glomeruosclerosis

Background: Preeclampsia is a common condition, complicating up to 5% of pregnancies, and is one of the leading causes of maternal and foetal morbidity worldwide. Apart from its distinguishing features of hypertension, potential presence of haemolysis or thrombocytopaenia, and intra-uterine growth restriction, it can cause proteinuria via a mechanism of endotheliosis and podocyte damage. The main renal histological finding is the presence of endotheliosis and urinalysis with special staining revealing podocyturia. Some women have persistent proteinuria following pregnancy, and in these patients this raises the possibility of secondary glomerular lesions. Focal segmental glomerulosclerosis (FSGS) has previously been documented at renal biopsy in patients with a history of preeclampsia, rather than endotheliosis.

Case series: We explore the history of four women, initially documented to have severe preeclampsia, with foetal growth restriction, proteinuria, and in one incidence placental abruption and foetal death in utero. They had no preceding history of diabetes or hypertension. Their median age was 27 years, with a normal serum creatinine at presentation (mean Cr 58 mcmol/L). Two patients were documented to have no proteinuria prior to pregnancy, whilst others first presented with proteinuria. Following their pregnancies, persistent proteinuria prompted a renal biopsy, at dates ranging 3–12 months post-partum. Mean creatinine at the time of biopsy was 100 mcmol/L, and albumin-creatinine ratio was 150 mg/mmol creat. In these patients, biopsy showed features of FSGS. Outcomes include ongoing chronic kidney disease in three patients, and one requiring dialysis four years following the presentation with preeclampsia.

Conclusions: Preeclampsia may be associated with the formation of secondary FSGS. This suggests that patients with preeclampsia should be followed up regularly to detect the development of a secondary glomerular lesion.