Successful treatment of nephrotic syndrome in twin pregnancy: case report

Nephrotic syndrome is a kidney disorder that is identified by signs of nephrosis, severe proteinuria, hypoalbuminemia, and edema. It is a component of glomerulonephrosis, in which different degrees of proteinuria may occur. The complications of this syndrome may include blood clots, infections, and high blood pressure. Essentially, decreased protein through the kidneys (proteinuria) leads to low protein levels in the blood (hypoproteinemia including hypoalbuminemia), which causes water to be drawn into soft tissues (edema). Severe hypoalbuminemia may also lead to different secondary problems, including water in the abdominal cavity (ascites), around the heart or lung (pericardial effusion, pleural effusion), high cholesterol (hyperlipidemia) and, loss of molecules regulating coagulation (increased risk of thrombosis). Other symptoms may be weight gain, feeling tiredness, and also foamy urine. This study aimed to introduce a case of successful treatment of nephrotic syndrome in twin pregnancy.

The patient was a 30-years old woman who presented with twin pregnancy in 31 weeks of gestation with a history of IVF (In-Vitro Fertilization) in the current pregnancy. She referred to Ghaem hospital of Mashhad University of Medical Sciences in March 2017 because of severe lower extremities edema and 3+ proteinuria. Considering severe proteinuria (more than 6 gr/24 hr), edema, hypoalbuminemia and hyperlipidemia, the nephrotic syndrome was diagnosed and she was treated with methylprednisolone, Hydrochlorothiazide and Fenofibrate. At last, premature rupture of membrane occurred at 36 weeks of gestation. Cesarean was done because of the breech presentation of both fetuses and two healthy neonates were born with an optimal Apgar score.

Early diagnosis of nephrotic syndrome and accurate prenatal care in these patients could have optimal pregnancy outcomes, especially if it was not complicated by hypertension and renal dysfunction.