Síndrome nefrótico secundario a preeclampsia: presentación, manejo y evolución clínica observados en 5 años de experiencia / Nephrotic syndrome due to preeclampsia: Presentation, management and clinical evolution observed in 5 years experience

Introducción: El síndrome nefrótico (SN) es una entidad rara durante el embarazo. En esta etapa, la preeclampsia (PE) severa es la principal causa. Nuestro objetivo fue describir la presentación clínica, las características analíticas, el manejo médico y la evolución de mujeres con SN por PE. Materiales y métodos: Estudio descriptivo, retrospectivo, realizado entre el 1 de enero de 2017 y el 1 de enero de 2022 (5años). Incluyó mujeres con embarazo ≥20semanas de edad gestacional (EG), internadas por trastorno hipertensivo del embarazo (THE), sin evidencia de daño renal previo a la gestación. Resultados: Entre 652 THE se identificaron 452 PE y 21 SN. La edad materna fue de 25±5,7 años, y la EG al diagnóstico, de 33,1±5,1 semanas. Todas presentaron edema facial y periféricos: 5 derrame pleural, 3 derrame pericárdico y 2 anasarca. La P24 fue de 6,17±2,34g (3,10-10,8), la albúmina sérica de 2,5±0,27g/dl (2,10-2,90) y el colesterol sérico de 281,4±21,7mg/dl (251-316). Hubo 13 que desarrollaron complicaciones maternas: daño renal agudo, edema pulmonar, miocardiopatía dilatada, eclampsia y síndrome HELLP. Todas permanecieron hipertensas en el posparto, requiriendo combinación de dos a tres fármacos antihipertensivos. En el posparto todas recibieron estatinas e inhibidores de la enzima convertidora de angiotensina (IECA) para el manejo de la proteinuria; ninguna desarrolló hiperkalemia o elevaciones de creatinina. La estancia hospitalaria fue de 10,4±3,7 días. Todas revirtieron los parámetros proteinúricos de rango nefrótico antes del alta. No se registraron muertes. Conclusión: La presentación incluyó desde edemas periféricos hasta compromiso seroso. La severidad de la proteinuria fue variable. El uso de IECA no precipitó hiperkalemia ni fallo renal. Las complicaciones maternas fueron frecuentes, pero no se observaron óbitos. (AU)

Introduction: Nephrotic syndrome (NS) is rare during pregnancy. The main cause is severe pre-eclampsia (PR). Our aim was to describe the clinical presentation, analytical features, medical management, and progress of women with NS due to PE. Materials and methods: A descriptive, retrospective study, conducted from 01/01/2017 to 01/01/2022 (5years). Women with a gestational age (GA) ≥20weeks were included in the study, hospitalised due to hypertensive disorders in pregnancy (HDP), with no evidence of kidney damage prior to gestation. Results: Of the 652 HDP, 452 PE and 21 NS were identified. Maternal age was 25±5.7 years, GA at diagnosis was 33.1±5.1 weeks. All the women had facial and peripheral oedema: 5 pleural effusion, 3 pericardial effusion, and 2 anasarca. Their p24 was 6.17±2.34grams (3.10-10.8), serum albumin 2.5±0.27g/dL (2.10-2.90), and serum cholesterol 281.4±21.7mg/dL (251-316). Thirteen developed maternal complications: acute kidney damage, pulmonary oedema, dilated cardiomyopathy, eclampsia, and HELLP syndrome. They all remained hypertensive postpartum, and required a combination of two to three antihypertensive drugs. They all received statins postpartum, and angiotensin converting enzyme (ACE) inhibitors to manage proteinuria. None developed hyperkalaemia or creatinine elevation. Hospital stay was 10.4±3.7days. All nephrotic range proteinuria parameters reversed prior to discharge. No deaths were recorded. Conclusion: Presentation ranged from peripheral oedema to serous involvement. Severity of proteinuria varied. Use of ACE inhibitors did not precipitate hyperkalaemia or kidney failure. Maternal complications were frequent, but no deaths were recorded. (AU)

[Nephrotic syndrome due to preeclampsia: Presentation, management and clinical evolution observed in 5 years experience]. / Síndrome nefrótico secundario a preeclampsia: presentación, manejo y evolución clínica observados en 5 años de experiencia.

INTRODUCTION: Nephrotic syndrome (NS) is rare during pregnancy. The main cause is severe pre-eclampsia (PR). Our aim was to describe the clinical presentation, analytical features, medical management, and progress of women with NS due to PE. MATERIALS AND METHODS: A descriptive, retrospective study, conducted from 01/01/2017 to 01/01/2022 (5years). Women with a gestational age (GA) ≥20weeks were included in the study, hospitalised due to hypertensive disorders in pregnancy (HDP), with no evidence of kidney damage prior to gestation. RESULTS: Of the 652 HDP, 452 PE and 21 NS were identified. Maternal age was 25±5.7 years, GA at diagnosis was 33.1±5.1 weeks. All the women had facial and peripheral oedema: 5 pleural effusion, 3 pericardial effusion, and 2 anasarca. Their p24 was 6.17±2.34grams (3.10-10.8), serum albumin 2.5±0.27g/dL (2.10-2.90), and serum cholesterol 281.4±21.7mg/dL (251-316). Thirteen developed maternal complications: acute kidney damage, pulmonary oedema, dilated cardiomyopathy, eclampsia, and HELLP syndrome. They all remained hypertensive postpartum, and required a combination of two to three antihypertensive drugs. They all received statins postpartum, and angiotensin converting enzyme (ACE) inhibitors to manage proteinuria. None developed hyperkalaemia or creatinine elevation. Hospital stay was 10.4±3.7days. All nephrotic range proteinuria parameters reversed prior to discharge. No deaths were recorded. CONCLUSION: Presentation ranged from peripheral oedema to serous involvement. Severity of proteinuria varied. Use of ACE inhibitors did not precipitate hyperkalaemia or kidney failure. Maternal complications were frequent, but no deaths were recorded.