Triple confusion: An interesting case of proteinuria in pregnancy

摘要

Pregnancy-related renal diseases are unique and need special attention, both for diagnosis and management. The major confounding factors for diagnosis are thephysiological multiorgan changes that occur throughout the gestational period. Proper diagnosis of the renal disease is also important, given the impact of variedmanagement options both on the maternal and fetal health. A young middle-aged female with a long-standing history of diabetes presented to the hospital withworsening proteinuria in her second trimester of pregnancy. Clinical history, examinations, and laboratory analysis did not give any clues for diagnosis of a specificdisease entity. This led us to take the risk of renal biopsy for a tissue diagnosis. The odds of renal biopsy favored the management decision in her case, therebyavoiding the confusions prior to biopsy. The pathological diagnosis is a surprise though not a unique entity on its own (minimal change disease in pregnancy). The caseillustrates the disparity of clinical presentations and the pathology in patients, and the importance of renal biopsy in pregnant patients in particular.