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

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.

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.

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.