P93
Renal Diagnoses and Outcomes in Women with Disease Identified During Pregnancy
Compared with Non-Pregnant Controls: A 2 Centre Cohort Study of 1406 Women
P Webster1, K Bramham2, L Webster2, H. Terence Cook1, C Horsfield2, I Lydon2, M Homsy2, R
Vaz1, C Santos1 & L Lightstone1.
1
Imperial College Healthcare NHS Trust Renal & Transplant Centre, Hammersmith Hospital
Maternal and Fetal Research Unit, King’s College London
2
Introduction: Chronic kidney disease (CKD) is estimated to affect 2% of women aged 1654yrs in England. Pregnancy is frequently the first time women are seen by health services, and
provides an opportunity to identify early disease. Our aims were i) To compare the aetiology
of renal disease diagnosed during/after pregnancy with disease identified in non-pregnant
women of child-bearing age; ii) To compare the long term renal outcomes of these two groups.
Methods: Native renal biopsies from 2 tertiary centres were studied (1997-2012). Renal disease
identified in pregnancy-related (PR) biopsies included antenatal and postpartum biopsies
investigating abnormalities recognised during pregnancy. Controls included biopsies from all
women of childbearing age (16 to 49yrs). First biopsies were included. Repeat and inadequate
biopsies were excluded.
Results: 174 PR biopsies (19 antenatal, 155 postpartum) were identified; mean age at biopsy
32.5yrs. 1232 biopsies in control women; mean age 35.4yrs. PR women were younger than
controls (p<0.0001). Follow-up time was similar between groups. Focal segmental
glomerulosclerosis (FSGS) was the most common diagnosis in PR biopsies and was more
frequent than in controls (PR - 59/174, 33.9%; Controls - 143/1232, 11.6%; p<0.0001). Control
patients had a higher incidence of lupus nephritis (p<0.001) and diabetic nephropathy
(p=0.036). There were no significant differences in other diagnoses between PR and control
biopsies. For women with FSGS, similar numbers reached end-stage renal disease requiring
renal replacement therapy (p=0.281) and there was no difference in rate of change in creatinine
between groups (median change in Cr/month PR = 0.17µmol/L (IQR 0.0, 1.2), control =
0.10µmol/L (IQR -.014, 0.71); p=0.228).
Conclusion: Renal diseases discovered during / after pregnancy occur at a younger age than in
non-pregnant controls. FSGS is the most common diagnosis identified during or after
pregnancy, but does not appear to be associated with worse long term renal outcomes compared
with disease identified in non-pregnant controls. It is currently unclear whether pregnancy
reveals or causes FSGS, or whether lesions are primary or secondary. Further work is needed to
explore the nature of FSGS lesions, and to define risk factors for progression in order to
optimise antenatal and postpartum management.