Mr. Morton et Km. Bannister, RENAL-FAILURE DUE TO MESANGIOCAPILLARY GLOMERULONEPHRITIS IN PREGNANCY - USE OF PLASMA-EXCHANGE THERAPY, Clinical nephrology, 40(2), 1993, pp. 74-78
A 20-year-old female became pregnant 4 years after diagnosis of type I
mesangiocapillary glomerulonephritis. Despite normal serum creatinine
at conception renal function deteriorated during pregnancy. The use o
f plasmapheresis and albumin substitution as well as antihypertensive
therapy enabled the continuation of the pregnancy from 27 weeks' gesta
tion until a healthy infant could be delivered at 33 weeks. However, a
n abrupt decline in function at delivery did not reverse and the patie
nt remains dialysis dependent. We conclude that plasma exchange therap
y with albumin substitution may be of benefit in women with mesangioca
pillary glomerulonephritis when renal function has deteriorated in pre
gnancy. Stabilization of renal function can allow continuation of the
pregnancy until greater fetal maturity makes the delivery of a healthy
infant more likely. Although plasma exchange is an experimental thera
py, in our hands it appears safe for the fetus and maternal complicati
ons were limited to minor vascular access problems. The best prognosti
c marker in this case was the severity of the most recent renal biopsy
rather than the level of renal function or hypertension at the start
of pregnancy. This contrasts with most reported cases of pregnancy and
primary glomerular disease where irreversible deterioration of renal
function was uncommon when renal function at the start of pregnancy wa
s only mildly impaired and hypertension well controlled.