Proteinuria in early pregnancy: Is it a reflection of chronic renal disease?

Abstract

Encountering pregnant women with significant proteinuria in the first trimester is rare, and it calls for investigating a renal cause. A 25-year-old primigravida was diagnosed with proteinuria during her first prenatal visit at 12 weeks. When investigated further, she was found to have bilateral renal cysts and chronic kidney disease (CKD) and, hence, was advised medical termination of pregnancy. At tertiary care Institute, her evaluation showed 22 weeks of pregnancy with live fetus and proteinuria of more than 1500 mg/day, and serum creatinine was 3.1 mg%. She was counseled and managed by a multidisciplinary team consisting of nephrologists and obstetricians. Apart from her routine hematinic, she had twice-weekly dialysis and received multiple blood transfusions, twiceweekly erythropoietin, low molecular weight heparin, and aspirin. She developed mild intrauterine growth restriction (IUGR) and had a planned vaginal delivery at 37 weeks, and delivered a neonate of 2.3 kg with an Apgar score of 9/10 at 5 min. The baby was observed in the neonatal intensive care unit (NICU) as the cord blood creatinine was high, which normalized after four days. Mother and baby were discharged after five days in good health; however, after six weeks, mother's renal function deteriorated, and she was hospitalized again for renal biopsy and further management under nephrology.