Alport syndrome and pregnancy: a case series and literature review

Francesca Brunini, Barbara Zaina, Davide Gianfreda, Wally Ossola, Marisa Giani, Luigi Fedele, Piergiorgio Messa, Gabriella Moroni

Research output: Contribution to journalArticle

Abstract

Purpose: To assess pregnancy outcome in women with Alport syndrome and the impact of pregnancy on the disease progression. Methods: We describe one of the largest series of pregnancies in Alport syndrome. Seven pregnancies of six women were monitored by a multidisciplinary team of nephrologists and gynecologists. After delivery, patients were followed for at least 3 years. We compare our results with those in the literature. Results: Pregnancy course was uneventful in the patient with isolated microscopic hematuria. In the other cases, all presenting mild proteinuria at conception, some complications occurred. Proteinuria worsened during the last trimester, reaching nephrotic ranges in five out of six pregnancies and was associated with fluid overload leading to hospitalizations and early delivery. The majority of the newborns had a low birth weight. The two patients with arterial hypertension at conception and twin pregnancy developed pre-eclampsia and renal function deterioration persisted after delivery. The one with pre-pregnancy renal dysfunction reached end-stage renal disease. In the other patients, in which renal function and blood pressure were and remained normal, proteinuria improved after delivery and no signs of disease progression were recorded at last observation. Conclusions: Our observations suggest that Alport syndrome should be considered a potential risk factor for pregnancy in proteinuric patients due to the development of pre-eclampsia, renal function deterioration, and/or full-blown nephrotic syndrome that results in anasarca, slowing of fetal growth and pre-term delivery. Thus, all women with Alport syndrome should receive pre-conceptional counseling and be kept in close follow-up during pregnancy.

Original languageEnglish
Pages (from-to)1421-1431
Number of pages11
JournalArchives of Gynecology and Obstetrics
Volume297
Issue number6
DOIs
Publication statusPublished - 2018

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Keywords

  • Alport syndrome
  • Fetal and maternal outcome
  • Kidney disease progression
  • Pregnancy
  • Proteinuria

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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