Skip to main content

Advertisement

SpringerLink
Log in

A case of hypertensive disorders of pregnancy that developed at 9 weeks of gestation

  • Case Report
  • Published:
CEN Case Reports Aims and scope Submit manuscript

Abstract

Preeclampsia and superimposed preeclampsia usually develop after 20 weeks of gestation. We report a case of a 35-year-old Japanese woman who developed hypertensive disorders of pregnancy (HDP) before 20 weeks of gestation. She presented with hypertension and proteinuria at 9 and 11 weeks of gestation, respectively, and developed nephrotic syndrome at 17 weeks of gestation. She did not have definite hypertension or urinary abnormalities before pregnancy. The patient was serologically positive for the antinuclear antibody. However, the complement levels were normal and anti-phospholipid antibody was not detected. A renal biopsy performed at 18 weeks of gestation showed diffuse endotheliosis and tip lesions of secondary focal segmental glomerulosclerosis but no hypertensive changes of the arterioles. Although electron microscopic examination showed electron-dense deposits in the subendothelial lesions, they were considered nonspecific plasma exudation by mass spectrometry. An abortion was performed at 20 weeks gestation because the patient’s congestive symptoms due to nephrotic syndrome had worsened and marked fetal growth restriction was observed. After delivery, the patient’s symptoms resolved immediately without any additional treatment; however, continuous antihypertensive medication was required. Finally, the patient was diagnosed with HDP based on the renal biopsy findings and her clinical course after delivery. Compared to previous reports, this case describes the earliest onset of HDP. Thus, HDP should be considered as a differential diagnosis in pregnant women with hypertension or proteinuria presenting with symptoms before 20 weeks of gestation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Makino S, Takeda J, Takeda S, Watanabe K, Matsubara K, Nakamoto O, Ushijima J, Ohkuchi A, Koide K, Mimura K, Morikawa M, Naruse K, Tanaka K, Nohira T, Metoki H, Kawabata I, Takagi K, Yamasaki M, Ichihara A, Kimura T, Saito S, Seki H. New definition and classification of “hypertensive disorders of pregnancy (HDP). Hypertens Res Pregnancy. 2019;7:1–5.

    Article  Google Scholar 

  2. Hazra S, Waugh J, Bosio P. ‘Pure’ pre-eclampsia before 20 weeks of gestation: a unique entity. BJOG. 2003;110:1034–5.

    Article  CAS  Google Scholar 

  3. Imasawa T, Nishiwaki T, Nishimura M, Shikama N, Matsumura R, Nagai M, Soyama A, Koike K, Kitamura H, Joh K. A case of “pure” preeclampsia with nephrotic syndrome before 15 weeks of gestation in a patient whose renal biopsy showed glomerular capillary endotheliosis. Am J Kidney Dis. 2006;48:495–501.

    Article  Google Scholar 

  4. Stillman IE, Karumanchi SA. The glomerular injury of preeclampsia. J Am Soc Nephrol. 2007;18:2281–4.

    Article  Google Scholar 

  5. Maya ID. Hypertension and proteinuria in a 17-year-old at 19weeks’gestation. Am J Kidney Dis. 2008;51:155–9.

    Article  Google Scholar 

  6. Tanaka M, Tsujimoto Y, Goto K, Kumahara K, Onishi S, Iwanari S, Fumihara D, Miki S, Ikeda M, Sato K, Sato H, Hirose M, Takeoka H. Preeclampsia before 20 weeks of gestation: a case report and review of the literature. CEN Case Rep. 2015;4:55–60.

    Article  Google Scholar 

  7. Liu J, Ghaziani TT, Wolf JL. Acute fatty liver disease of pregnancy: updates in pathogenesis, diagnosis, and management. Am J Gastroenterol. 2017;112:838–46.

    Article  CAS  Google Scholar 

  8. Paller MS. Hypertension in pregnancy. J Am Soc Nehorol. 1998;9:314–21.

    Article  CAS  Google Scholar 

  9. Pignatelli P, Ettorre E, Menichelli D, Pani A, Violi F, Pastori D. Seronegative antiphospholipid syndrome:refining the value of “non-criteria” antibodies for diagnosis and clinical management. Haematologica. 2020;105:562–72.

    Article  CAS  Google Scholar 

  10. Fakhouri F, Roumenina L, Provot F, Sallée M, Caillard S, Couzi L, Essig M, Ribes D, Dragon-Durey MA, Bridoux F, Rondeau E, Frémeaux-Bacchi V. Pregnancy-associated hemolytic uremic syndrome revisited in the era of complement gene mutations. J Am Soc Nephrol. 2010;21:859–67.

    Article  CAS  Google Scholar 

  11. Abisror N, Nguyen Y, Marozio L, Valverde EE, Udry S, Pleguezuelo DE, Billoria P, Mayer PK, Urbanski G, Zigon P, Moreuil CD, Hoxha A, Bezanahary H, Carbillion L, Kayem G, Bornes M, Yelnik C, Johanet C, Nicaise RP, Lambert M, Salle V, Latino OJ, Hachulla E, Benedetto C, Bourrienne MC, Benhamou Y, Alijotas RJ, Fain O, Mekinian A. Obstetrical outcome, and treatments in seronegative primary APS: data from European retrospective study. RMD Open. 2020;6:e001340.

    Article  Google Scholar 

  12. Oku K, Atsumi T, Bohgaki M, Amengual O, Kataoka H, Horita T, Yasuda S, Koike T. Complement activation in patients with primary antiphospholipid syndrome. Ann Rheum Dis. 2009;68:1030–5.

    Article  CAS  Google Scholar 

  13. Nochy D, Daugas E, Droz D, Beaufils H, Grunfeld JP, Piette JC, Bariety J, Hill G. The intrarenal vascular lesions associated with primary antiphospholipid syndrome. J Am Soc Nephrol. 1999;10:507–18.

    Article  CAS  Google Scholar 

  14. Mekinian A, Bourrienne MC, Carbillon L, Benbara A, Noemie A, Chollet MS, Tigaizin A, Montestruc F, Fain O, Nicaise RP. Non-conventional antiphospholipid antibodies in patients with clinical obstetrical APS: Precvalence and treatment efficacy in pregnancies. Semin Arthritis Rheum. 2016;46:232–7.

    Article  Google Scholar 

  15. Japan Society for the Study of HYPERTENSION IN PREGNANCY. Best Practice Guide 2015 for Care and Treatment of Hypertension in Pregnancy. 1st ed. Medical View; 2015

  16. Rey E, Couturier A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol. 1994;171:410–6.

    Article  CAS  Google Scholar 

  17. Qin J, Liu X, Sheng X, Wang H, Gao D. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril. 2016;105:73–85.

    Article  Google Scholar 

  18. Sites CK, Wilson D, Barsky M, Bernson D, Bernstein IM, Boulet S, Zhang Y. Embryo cryopreservation and preeclampsia risk. Fertil Steril. 2017;108:784–90.

    Article  Google Scholar 

  19. Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennström M, Olovsson M, Brennecke SP, Stepan H, Allegranza D, Dilba P, Schoedl M, Hund M, Verlohren S. Predictive Value of the sFlt-1: PlGF Ratio in Women with Suspected Preeclampsia. N Engl J Med. 2016;374:13–22.

    Article  CAS  Google Scholar 

  20. Thadhani R, Hagmann H, Schaarschmidt W, Roth B, Cingoez T, Karumanchi SA, Wenger J, Lucchesi KJ, Tamez H, Lindner T, Fridman A, Thome U, Kribs A, Danner M, Hamacher S, Mallmann P, Stepan H, Benzing T. Removal of soluble fms-like tyrosine kinase-1 by dextran sulfate apheresis in preeclampsia. J Am Soc Nephrol. 2016;27:903–13.

    Article  CAS  Google Scholar 

  21. Nakashima A, Yamanaka-Tatematsu M, Fujita N, Koizumi K, Shima T, Yoshida T, Nikaido T, Okamoto A, Yoshimori T, Saito S. Impaired autophagy by soluble endoglin, under physiological hypoxia in early pregnant period, is involved in poor placentation in preeclampsia. Autophagy. 2013;9:303–16.

    Article  CAS  Google Scholar 

  22. Seki H. Balance of antiangiogenic and angiogenic factors in the context of the etiology of preeclampsia. Acta Obstet Gynecol Scand. 2014;93:959–64.

    Article  Google Scholar 

  23. Sani HM, Vahed SZ, Ardalan M. Preeclampsia: a close look at renal dysfunction. Biomed Pharmacother. 2019;109:408–16.

    Article  Google Scholar 

  24. Levine RJ, Maynard SE, Qian C, Lim K, England LJ, Yu KF, Schisterman EF, Thadhani R, Sachs BP, Epstein FH, Sibai BM, Sukhatme VP, Karumanchi SA. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med. 2004;350:672–83.

    Article  CAS  Google Scholar 

  25. Saito S, Sakai M, Sasaki Y, Nakashima A, Shiozaki A. Inadequate tolerance induction may induce preeclampsia. J Reprod Immunol. 2007;76:30–9.

    Article  CAS  Google Scholar 

  26. Sasaki Y, Kolarz DD, Suzuki D, Sakai M, Ito M, Shima T, Shiozaki A, Rolinski J, Saito S. Proportion of peripheral blood and decidual CD4+ CD25bright regulatory T cells in pre-eclampsia. Clin Exp Immunol. 2007;149:139–45.

    Article  CAS  Google Scholar 

  27. Jennette JC, Olson JL, Schwartz MM, Silva FG. Heptinstall’s pathology of the kidney: hypertensive disorders of pregnancy, vol. 6. Netherlands: Wolters Kluwer; 2007. p. 773–85.

    Google Scholar 

  28. Zhang J, Troendle JF, Levine RJ. Risks of hypertensive disorders in the second pregnancy. Paediatr Perinat Epidemiol. 2001;15:226–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku Hamamatsu, Hamamatsu, 431-3192, Japan

    Saki Hayashi, Naro Ohashi, Daiki Goto, Shinsuke Isobe, Tomoyuki Fujikura & Hideo Yasuda

  2. Department of Obstetrics and Gynecology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Naomi Isomura & Hiroaki Ito

  3. Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Yoshihide Fujigaki

  4. Department of Pathology, Nihon University School of Medicine, Tokyo, Japan

    Akira Shimizu

Authors
  1. Saki Hayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Naro Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daiki Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naomi Isomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shinsuke Isobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tomoyuki Fujikura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshihide Fujigaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akira Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hideo Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Naro Ohashi.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hayashi, S., Ohashi, N., Goto, D. et al. A case of hypertensive disorders of pregnancy that developed at 9 weeks of gestation. CEN Case Rep 10, 476–482 (2021). https://doi.org/10.1007/s13730-021-00592-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13730-021-00592-z

Keywords

Search

Navigation