Department of Nephrology, National Institute of Perinatology "Isidro Espinoza de los Reyes", Mexico City, Mexico.
Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico.
Am J Kidney Dis. 2019 Dec;74(6):837-843. doi: 10.1053/j.ajkd.2019.04.026. Epub 2019 Aug 1.
The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.
局灶节段性肾小球硬化症（FSGS）与妊娠的关系复杂且尚未完全阐明。FSGS 患者妊娠存在较高的并发症风险，这可能与血流动力学因素、血管生成和抗血管生成因子失衡以及激素条件有关。尽管在妊娠以外的情况下与塌陷性 FSGS 相关的不良临床结局较为常见，但在妊娠期间的预后情况记录不佳。我们报告了 3 例在妊娠期间发生塌陷性 FSGS 的患者，其中 2 例患者存在推测的潜在 FSGS。2 例患者在妊娠期间进行了活检，1 例在产褥期进行了活检。这 3 例患者在分娩后均未自发改善，1 例患者在分娩后肾功能和蛋白尿迅速恶化。强化免疫抑制治疗在 1 例（无慢性病变）患者中取得完全缓解，在其余 2 例患者中取得部分缓解。这些病例提示，对于在妊娠期间血清肌酐水平或蛋白尿迅速升高的 FSGS 患者，应考虑存在塌陷性病变，且这些病变至少部分可对治疗产生应答。
