Nephrotic syndrome in early pregnancy—is renal biopsy always necessary?

(Section Editor: K. Kühn) Increased proteinuria in pregnancy is common, ranging from a slight elevation to nephrotic amounts. In early pregnancy, nephrotic proteinuria with hypertension is considered suggestive of native renal disease rather than pre‐eclampsia [1]. Diagnosis and proper management are very important for maternal and fetal health [2]. Overall, glomerular lesions associated with pre‐eclampsia are the commonest findings in pregnant renal biopsies and the changes are reversible without any long‐term sequelae [3]. Here we present a case of early nephrotic syndrome with hypertension associated with a triploid fetus and a placenta with a partial mole. Nephrotic syndrome and hypertension resolved when the pregnancy was terminated. Renal biopsy and steroids were not required. A 24‐year‐old primigravid woman with oedema and hypertension was referred for nephrological opinion after an ultrasound confirmed 15 weeks of gestation. She had noticed facial and periorbital oedema at 13 weeks gestation. There was a family history of Henoch–Schonlein purpura. On examination her blood pressure was 150/100 mmHg. The jugular venous pressure was raised. She had lower limb and sacral oedema. Clinical urinalysis showed proteinuria +++ and blood +. Her blood pressure rose to 178/110 mmHg over the following few days. Laboratory investigations showed serum sodium 131 mmol/l, potassium 4.3 mmol/l, urea 5.4 mmol/l, creatinine 72 mmol/l, albumin 26 g/l, 24 h urinary protein 3.72 g, haemoglobin 9.4 g/dl. MCV was 86.9 fl; serum vitamin B12 and folate levels and immunological screen were normal except low IgG 4.75 g/l (6–16 g/l). The ultrasound scan of her kidneys showed 10.2 cm size with normal echotexture. Bilateral pleural effusions were noticed. Echocardiogram was normal. Chest X‐ray showed signs of fluid overload.