Diabetic nephropathy unmasked in pregnancy: a case report

Authors

  • Nithya Jagadeesan Department of Obstetrics and Gynecology, GKNM Hospital, Coimbatore, Tamil Nadu, India
  • Aishwarya Sudhager Department of Obstetrics and Gynecology, GKNM Hospital, Coimbatore, Tamil Nadu, India
  • Goutham Seralathan Division of Nephrology, GKNM Hospital, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20241785

Keywords:

Diabetic Nephropathy, Preeclampsia, Pregnancy

Abstract

Nephropathy complicates 5-10% of pregnancies in women with diabetes and is associated with adverse maternal and fetal outcome. Degree of renal impairment and proteinuria in early pregnancy predicts pregnancy outcome. Diabetes presenting as nephropathy at diagnosis is less frequent. We report a case of biopsy proven diabetic nephropathy that was diagnosed during second trimester of pregnancy when she presented with early onset preeclampsia with nephrotic range proteinuria, moderate anemia. Anti hypertensives and insulin were titrated. She was on strict antepartum fetal surveillance. She had periodic follow up with nephrologist. Caesarean section was performed at 33 weeks because of imminent eclampsia with transverse lie. Postoperative recovery was uneventful. Control of hypertension is cornerstone in the management as this delays the progression of the disease.

Metrics

Metrics Loading ...

References

Carr DB, Koontz GL, Gardella C, Holing EV, Brateng DA, Brown ZA, et al. Diabetic Nephropathy in Pregnancy: Suboptimal Hypertensive Control Associated With Preterm Delivery. American Journal of Hypertension. 2006;19(5):513-9.

Raets L, Ingelbrecht A, Benhalima K. Management of type 2 diabetes in pregnancy: a narrative review. Front Endocrinol (Lausanne). 2023;14:1193271.

Clausen P, Ekbom P, Damm P, Feldt-Rasmussen U, Nielsen B, Mathiesen ER, et al. Signs of maternal vascular dysfunction precede preeclampsia in women with type 1 diabetes. J Diabetes Complications. 2007;21:288-93.

Mathiesen Elisabeth R, Lene R, Bo F, Peter C, Peter D. Obstetric Nephrology: Pregnancy in Women with Diabetic Nephropathy-The Role of Antihypertensive Treatment. Clinical Journal of the American Society of Nephrology. 2012;7(12):2081-28.

Holmes VA, McCance DR. Could antioxidant supplementation prevent pre-eclampsia? Proc Nutr Soc. 2005;64:491-501.

Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. RENAAL Study Investigators: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-9.

Sibai BM. Diabetic nephropathy in pregnancy. In: A Practical Manual of Diabetes in Pregnancy, Chichester, UK, Blackwell Publishing; 2008:153-156.

Hypertension in pregnancy: diagnosis and management. NICE guideline Published: 25 June 2019. Available at: www.nice.org.uk/guidance/ng133. Accessed on 20 December 2023.

Abalos E, Duley L, Steyn DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2018;10:CD002252.

Hladunewich MA, Bramham K, Jim B, Maynard S. Managing glomerular disease in pregnancy. Nephrol Dial Transplant. 2017;32:i48-i56.

Downloads

Published

2024-06-27

How to Cite

Jagadeesan, N., Sudhager, A., & Seralathan, G. (2024). Diabetic nephropathy unmasked in pregnancy: a case report. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(7), 1842–1844. https://doi.org/10.18203/2320-1770.ijrcog20241785

Issue

Section

Case Reports