Does Pre-Eclampsia Predispose Patients to the Development of Focal Segmental Glomerulosclerosis? “The Chicken or the Egg?

<p>Pre-eclampsia is the most common medical complication of pregnancy affecting 3-5% of pregnancies worldwide. Traditional teaching has generally maintained that the natural history of Preeclampsia is one of resolution of renal pathology and other clinical features- some days to weeks after delivery of the placenta. Renal injury is mediated by both endothelial and podocyte injury in pre-eclampsia. In some women however, the renal injury does not resolve and proteinuria persists following pregnancy. The development of further glomerular lesions, notably focal segmental glomerulosclerosis (FSGS) following pre-eclampsia, has previously been described, and is an association that is increasingly recognized.</p> <p>Here we describe a heterogeneous case series of four women seen in our unit over a five year period who were diagnosed with FSGS some months to years following a pregnancy complicated by pre-eclampsia. These cases illustrate the complex and individual relationship that might exist between pre-eclampsia and FSGS lesions.</p> <p>We also discuss current concepts in our understanding of the pathophysiology behind the complex relationship between podocyte injury in pregnancy and subsequent FSGS lesions in some women.</p>