Alport syndrome and pregnancy: a case series and literature review
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To assess pregnancy outcome in women with Alport syndrome and the impact of pregnancy on the disease progression.
We describe one of the largest series of pregnancies in Alport syndrome. Seven pregnancies of six women were monitored by a multidisciplinary team of nephrologists and gynecologists. After delivery, patients were followed for at least 3 years. We compare our results with those in the literature.
Pregnancy course was uneventful in the patient with isolated microscopic hematuria. In the other cases, all presenting mild proteinuria at conception, some complications occurred. Proteinuria worsened during the last trimester, reaching nephrotic ranges in five out of six pregnancies and was associated with fluid overload leading to hospitalizations and early delivery. The majority of the newborns had a low birth weight. The two patients with arterial hypertension at conception and twin pregnancy developed pre-eclampsia and renal function deterioration persisted after delivery. The one with pre-pregnancy renal dysfunction reached end-stage renal disease. In the other patients, in which renal function and blood pressure were and remained normal, proteinuria improved after delivery and no signs of disease progression were recorded at last observation.
Our observations suggest that Alport syndrome should be considered a potential risk factor for pregnancy in proteinuric patients due to the development of pre-eclampsia, renal function deterioration, and/or full-blown nephrotic syndrome that results in anasarca, slowing of fetal growth and pre-term delivery. Thus, all women with Alport syndrome should receive pre-conceptional counseling and be kept in close follow-up during pregnancy.
KeywordsAlport syndrome Pregnancy Fetal and maternal outcome Kidney disease progression Proteinuria
FB data collection, data analysis, and manuscript writing/editing. BZ clinical assessment of mothers and fetus during pregnancy and patient follow-up. DG data collection. WO clinical assessment of mothers and fetus during pregnancy and patient follow-up. MG patient follow-up at diagnosis. LF paper assessment. PGM paper assessment. GM project development; clinical assessment of mothers and fetus during pregnancy and patient follow-up; data analysis and manuscript writing/editing.
No supplemental funding was provided for this research.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRCCS Ca’ Granda Ospedale Maggiore Policlinico ethics committee-Milano area B- and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
Data were collected retrospectively in an anonymous database without interfering with the best clinical practice at any time during patients’ follow-up. Due to the retrospective nature of the study, neither written nor verbal informed consent was necessary, according to the ethical standards of the institutional Ethics Committee.
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