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De Novo GN Pregnancy — ESENeph MCQ

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HardPregnancy & RenalDe Novo GN PregnancyESENeph

A 30-year-old woman develops new-onset nephrotic syndrome during the third trimester of pregnancy (34 weeks). She has no pre-existing renal disease. Complement levels are normal. She has no features of pre-eclampsia. What is the most likely diagnosis?

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Correct answer: D — New-onset primary glomerular disease (e.g. minimal change disease or membranous nephropathy) – rare but occurs; kidney biopsy may need to be deferred until postpartum

While pre-eclampsia is the most common cause of new proteinuria in the third trimester, if pre-eclampsia features are absent (no hypertension, no organ dysfunction, normal platelets/LFTs), de novo glomerular disease should be considered. MCD and MN can present for the first time during pregnancy. Kidney biopsy during pregnancy is technically feasible (up to ~32 weeks) but carries higher bleeding risk. If the clinical situation allows, biopsy may be deferred until postpartum. Supportive management and close monitoring are essential. Delivery planning should consider both maternal and fetal factors.

Reference: UKKA 2019 – Pregnancy in CKD; Wiles et al 2019