| Autor: |
Orozco Guillén AO; Department of Nephrology, National Institute of Perinatology 'Isidro Espinoza de los Reyes', Mexico City 11000, Mexico. ale_gaba@hotmail.com., Velazquez Silva RI; Department of Nephrology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico. ricardo.ivan.velaz@gmail.com., Moguel González B; Department of Nephrology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14080, Mexico. bernardomoguel@hotmail.com., Guell YA; Department of Foetal Medicine, National Institute of Perinatology 'Isidro Espinoza de los Reyes', Mexico City 11000, Mexico. dra_amaya@hotmail.com., Garciadiego Fossas P; Department of Infectolog, National Institute of Perinatology 'Isidro Espinoza de los Reyes', Mexico City 11000, Mexico. drapamelagf@yahoo.com., Custodio Gómez IG; Department of Gynaecology and Obstetrics, National Institute of Perinatology 'Isidro Espinoza de los Reyes', Mexico City 11000, Mexico. iriscustodio15@gmail.com., Miranda Araujo O; Department of Gynaecology and Obstetrics, National Institute of Perinatology 'Isidro Espinoza de los Reyes', Mexico City 11000, Mexico. drosvaldomiranda@gmail.com., Soto Abraham V; Department of Pathology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14000, Mexico. vigiliasoto@gmail.com., Piccoli GB; Department of Clinical and Biological Sciences University of Torino, 10043 Torino, Italy. gbpiccoli@yahoo.it.; Department of Nephrology, Centre Hospitalier Le Mans, 72000 Le Mans, France. gbpiccoli@yahoo.it., Madero M; Department of Pathology, National Institute of Cardiology 'Ignacio Chávez', Mexico City 14000, Mexico. madero.magdalena@gmail.com. |
| Abstrakt: |
Chronic kidney disease (CKD) is increasingly recognized as a risk factor in pregnancy; the differential diagnosis between CKD and preeclampsia (PE) may be of pivotal importance for pregnancy management and for early treatment of CKD. Acknowledging this connection may be useful also in a wider context, such as in the case reported in this paper, which for the first time describes an association between syphilis infection and IgA-dominant glomerulonephritis. A 16-year-old woman, referred to a general hospital due to a seizure, was found to be unknowingly pregnant. Based on hypertension and nephrotic proteinuria, she was initially diagnosed with PE. Immunological tests, as well as hepatitis and HIV tests showed negative results. However, secondary syphilis was diagnosed. In discordance with the PE diagnosis, urinalysis showed glomerular microhematuria with cellular casts. Proteinuria and hypertension did not remit after delivery, which was made via caesarean section, due to uncontrolled hypertension, at an estimated gestational age of 29 weeks. A male baby, weighing 1.1 kg (6.5 centile) was born. The baby was hospitalized in the neonatal intensive care unit, where he developed subependymal hemorrhage and thrombocytopenia, and neonatal syphilis was diagnosed. The mother underwent a kidney biopsy one week after delivery, leading to the diagnosis of IgA-dominant postinfectious glomerulonephritis. Mother and child were treated with support and antibiotic therapy, and were discharged in good clinical conditions four weeks later. Four months after delivery, the mother was normotensive without therapy, with normal kidney function and without hematuria or proteinuria. In conclusion, this case suggests that IgA-dominant postinfectious glomerulonephritis should be added to the spectrum of syphilis-associated glomerulonephritides, and underlines the need for a careful differential diagnosis with CKD in all cases of presumed PE. While diagnosis relies on kidney biopsy, urinary sediment, a simple and inexpensive test, can be the first step in distinguishing PE from other nephropathies. |
