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Pre-eclampsia Glomerular Endotheliosis — ESENeph MCQ

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ModeratePregnancy & RenalPre-eclampsia Glomerular EndotheliosisESENeph

A 30-year-old woman with severe pre-eclampsia at 30 weeks gestation has just been given antenatal corticosteroids for fetal lung maturity. She develops AKI with creatinine rising from 55 to 130 umol/L. What is the most likely renal pathology?

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Correct answer: D — Pre-eclampsia-associated glomerular endotheliosis (endothelial swelling and loss of fenestrae in glomerular capillaries) causing reduced GFR and proteinuria

The characteristic renal lesion of pre-eclampsia is glomerular endotheliosis: endothelial cell swelling with loss of fenestrae, occluding capillary lumens and reducing GFR. This is driven by anti-angiogenic factors (sFlt-1, soluble endoglin) released from the placenta, which antagonise VEGF and cause widespread endothelial dysfunction. The lesion is typically reversible after delivery. AKI in pre-eclampsia is usually mild but severe cases may require supportive care or RRT. Antenatal steroids are given for fetal lung maturity and do not cause nephropathy.

Reference: NICE NG133 2019 – Pre-eclampsia; Karumanchi 2016 – Pre-eclampsia Pathogenesis