A Single-Center Review of the Outcomes and Safety of Renal Biopsy in Pregnancy

Salah M Bashir; John Nel; William Bates

doi:10.26719/LJMR.18.2.04

Authors

Salah M Bashir Division of Nephrology, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. Author
John Nel Division of Nephrology, Department of Internal Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. Author
William Bates Division of Anatomical Pathology, Department of Pathology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. Author

DOI:

https://doi.org/10.26719/LJMR.18.2.04

Keywords:

Pregnancy, glomerulonephritis, pre-eclampsia, hypertension

Abstract

Purpose: Renal disease is rare in pregnancy but presents a clinical dilemma with the safety profile of kidney biopsies
during pregnancy unclear. Current guidelines have no consensus on the indication and timing, or criteria for selecting
patients on, whom the benefits of a renal biopsy during pregnancy outweigh the risks of performing a safe renal biopsy.
The aims of our research study were to determine the impact and safety of renal biopsy in the management of pregnant
patients with renal diseases at Tygerberg Hospital from 1990 to 2019.
Methods: A series of percutaneous renal biopsies performed in 21 pregnant women with renal disease presenting during
pregnancy over the past 30 years (1990–2019) were reviewed. Indications, timing, post-biopsy complications,
histopathologic findings, management, and maternal and fetal outcome were reviewed for each case.
Results: The main indication for renal biopsy was suspected of glomerular diseases (81%). The median gestational age at
the time of biopsy was fifteen weeks and six days in the range of 2-32 weeks. No patient developed any bleeding post
renal biopsy (hematuria, subcapsular renal bleed , retroperitoneal bleed) . Most of the women had a glomerular disorder on
renal biopsy, with mesangiocapillary glomerulonephritis (MCGN) being the most common histological diagnosis (23.8%).
Six patients required conservative treatment only, while 14 patients required additional steroids, and only one patient
required both steroids and an immunosuppressive agent. Out of 21 women patients, 14 (66.7%) had developed chronic
kidney disease, while seven (33.3%) patients had normal kidney function. Eleven (52.5%) of the pregnant women had a
normal delivery, while seven (33.3%) had a termination of pregnancy (MTOR), two premature deliveries after 33 weeks
to save the kidneys during delivery, and one miscarriage .
Conclusions: A renal biopsy performed during pregnancy is not contraindicated, and pregnancy didn’t lead to an
increased risk of biopsy bleeding in our study, Results of histopathological studies are useful to and, in advising
continuation or termination of pregnancy, recommend specific therapeutic modalities.

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