Fiziológiás terhesség során is jelentős morfológiai, funkcionális, hemodinamikai változások történnek a vesében, melyek következtében kismértékben fokozódik a proteinuria. Ennek kóros mértékű növekedése azonban, főleg ha hypertoniával, illetve vesefunkció-beszűküléssel is jár, szoros anyai, valamint magzati nyomon követést igényel, hiszen súlyos perinatalis szövődményeket vetíthet előre. A proteinuria differenciáldiagnosztikája szerteágazó, az etiológia tisztázásakor elsődleges szempont a praeeclampsia, illetve az egyéb, esetleges primer vesebetegség elkülönítése. Sorra vesszük az etiológiai palettán fellelhető mindazon kórképeket, amelyek akár a praeeclampsia tünettanát is utánozhatják, megnehezítve ezáltal a pontos diagnózis felállítását. A 31 éves várandós esete kapcsán a terhesség során észlelt progrediáló proteinuria differenciáldiagnosztikáját tekintjük át. Postpartum egyértelművé vált a praeeclampsia diagnózisa, mellékleletként azonban vesemalignitás igazolódott. Arra is keressük a választ, vajon a vese rosszindulatú daganata felelőssé tehető-e a hypertoniát, progrediáló proteinuriát magában foglaló klinikumért. Orv Hetil. 2022; 163(34): 1362–1368.
Bartal MF, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance. Am J Obstet Gynecol. 2022; 226(2 Suppl): S819–S834.
Lei T, Qiu T, Liao W, et al. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol. 2021; 19: 71.
Alasztics B, Kukor Z, Pánczél Z, et al. The pathophysiology of preeclampsia in view of the two-stage model. [A praeeclampsia kórélettana a kétlépcsős modell tükrében.] Orv Hetil. 2012; 153: 1167–1176. [Hungarian]
Li DK, Wi S. Changing paternity and the risk of preeclampsia/eclampsia in the subsequent pregnancy. Am J Epidemiol. 2000; 151: 57–62.
Morton A, Burke M, Jarvis E, el al. Changes in proteinuria and diagnosing preeclampsia in CKD pregnancy. Pregnancy Hypertens. 2020; 20: 92–95.
Cornelis T, Odutayo A, Keunen J, et al. The kidney in normal pregnancy and preeclampsia. Semin Nephrol. 2011; 31: 4–14.
Airoldi J, Weinstein L. Clinical significance of proteinuria in pregnancy. Obstet Gynecol Surv. 2007; 62: 117–124.
Hussein W, Lafayette RA. Renal function in normal and disordered pregnancy. Curr Opin Nephrol Hypertens. 2014; 23: 46–53.
Osman O, Maynard S. Proteinuria in pregnancy – review. Front Women’s Health 2019; 4: 1–5.
Cheung K, Lafayette RA. Renal physiology of pregnancy. Adv Chronic Kidney Dis. 2013; 20: 209–214.
Banoth P, Chaudhary K. Proteinuria: a presenting manifestation of mirror syndrome in pregnancy. Clin Nephrol. 2018; 90: 60–63.
Tanner MS, Davey MA, Mol BW et al. The evolution of the diagnostic criteria of preeclampsia-eclampsia. Am J Obstet Gynecol. 2022; 226(2 Suppl): S835–S843.
Xu X, Wang Y, Xu H, et al. Association between proteinuria and maternal and neonatal outcomes in pre-eclampsia pregnancy: a retrospective observational study. J Int Med Res. 2000; 48: 300060520908114.
Kendrick J, Sharma S, Holmen J, et al. Kidney disease and maternal and fetal outcomes in pregnancy. Am J Kidney Dis. 2015; 66: 55–59.
Feng Z, Minard C, Raghavan R. Pregnancy outcomes in advanced kidney disease. Clin Nephrol. 2015; 83: 272–278.
Guida JP, Parpinelli MA, Surita FG, et al. The impact of proteinuria on maternal and perinatal outcomes among women with pre-eclampsia. Int J Gynaecol Obstet. 2018; 143: 101–107.
De Castro I, Easterling TR, Bansal N, et al. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017; 91: 1464–1472.
Piccoli, GB, Cabiddu G, Attini R, et al. Risk of adverse pregnancy outcomes in women with CKD. J Am Soc Nephrol. 2015; 26: 2011–2022.
He Y, Liu J, Cai Q, et al. The pregnancy outcomes in patients with stage 3-4 chronic kidney disease and the effects of pregnancy in the long-term kidney function. J Nephrol. 2018; 31: 953–960.
Zhang JJ, Ma XX, Hao L, et al. A systematic review and meta-analysis of outcomes of pregnancy in CKD and CKD outcomes in pregnancy. Clin J Am Soc Nephrol. 2015; 10: 1964–1978.
Tanaka M, Iwanari S, Tsujimoto Y, et al. Pregnancy is a risk factor for secondary focal segmental glomerulosclerosis in women with a history of very low birth weight. Intern Med. 2017; 56: 1537–1541.
Piccoli GB, Kooij IA, Attini R, et al. A systematic review on materno-foetal outcomes in pregnant women with IgA nephropathy: a case of “late maternal” preeclampsia? J Clin Med. 2018; 7: 212.
Su X, Lv J, Liu Y, et al. Pregnancy and kidney outcomes in patients with IgA nephropathy: a cohort study. Am J Kidney Dis. 2017; 70: 262–269.
Liu Y, Ma X, Lv J, et al. Risk factors for pregnancy outcomes in patients with IgA nephropathy: a matched cohort study. Am J Kidney Dis. 2014; 64: 730–736.
Buyon JP, Kim MY, Guerra MM, et al. Predictors of pregnancy outcomes in patients with lupus: a cohort study. Ann Intern Med. 2015; 163: 153–163.
Blom K, Odutayo A, Bramham K, et al. Pregnancy and glomerular disease. A systematic review of the literature with management guidelines. Clin J Am Soc Nephrol. 2017; 12: 1862–1872.
Smyth A, Radovic M, Garovic VD. Women, kidney disease, and pregnancy. Adv Chronic Kidney Dis. 2013; 20: 402–410.
Covella B, Vinturache AE, Cabiddu G, et al. A systematic review and meta-analysis indicates long-term risk of chronic and end-stage kidney disease after preeclampsia. Kidney Int. 2019; 96: 711–727.
Ponticelli C, Moroni G. Is preeclampsia a risk for end-stage renal disease? Kidney Int. 2019; 96: 547–549.
Montersino B, Menato G, Colla L, et al. A young woman with proteinuria and hypertension in pregnancy: is what looks and smells like preeclampsia always preeclampsia? J Nephrol. 2021; 34: 1677–1679.
Piccoli GB, Attini R, Parisi S, et al. Excessive urinary tract dilatation and proteinuria in pregnancy: a common and overlooked association? BMC Nephrol. 2013; 14: 52.
Zhao Yi, Yang Z, Xu W, et al. Management of renal tumors during pregnancy: case reports. BMC Nephrol. 2021; 22: 127.
Dell’Atti L, Borghi C, Galosi AB. Laparoscopic approach in management of renal cell carcinoma during pregnancy. State of the art. Clin Genitourin Cancer 2019; 17: e822–e830.
Binbay M, Yuruk E, Ucpinar B, et al. Laparoscopic partial nephrectomy for renal cell carcinoma during pregnancy. J Endourol. 2016; 2: 18–20.
Dong J, Zhao Y, Xu W. Case report: retroperitoneal laparoscopic partial nephrectomy for T2 renal cell carcinoma during pregnancy. Front Oncol. 2020; 10: 552228.
Khaled H, Lahloubi NA, Rashad N. Review on renal cell carcinoma and pregnancy: a challenging situation. J Adv Res. 2016; 7: 575–580.
Ohyama T, Shimbo M, Endo F, et al. Renal cell carcinoma treatment during pregnancy: histopathological findings suggestive of rapid tumor growth. IJU Case Rep. 2019; 2: 265–268.
Lambe M, Lindblad P, Wuu J, et al. Pregnancy and risk of renal cell cancer: a population-based study in Sweden. Br J Cancer 2002; 86: 1425–1429.
Yilmaz E, Oguz F, Tuncay G, et al. Renal cell carcinoma diagnosed during pregnancy: a case report and literature review. J Int Med Res. 2018; 46: 3422–3426.
Boussios S, Pavlidis N. Renal cell carcinoma in pregnancy: a rare coexistence. Clin Transl Oncol. 2014; 16: 122–127.
Scavuzzo A, Santana Rios Z, Diaz-Gomez C, et al. Renal cell carcinoma in a pregnant woman with horseshoe kidney. Urol Case Rep. 2017; 13: 58–60.
Domján Z, Holman E, Bordás N, et al. Hand-assisted laparoscopic radical nephrectomy in pregnancy. Int Urol Nephrol. 2014; 46: 1757–1760.
Xu H, Tan S. Diagnosis and treatment of renal cell carcinoma during pregnancy. Cancer Manag Res. 2021; 13: 9423–9428.
Binbay M, Yuruk E, Ucpinar B, et al. Laparoscopic partial nephrectomy for renal cell carcinoma during pregnancy. J Endourol Case Rep. 2016; 2: 18–20.
David RA, Idowu B, Akindiose C, et al. Peculiarities and management challenges of advanced renal cell carcinoma incidentally discovered in pregnancy. Clin Case Rep. 2018; 6: 863–866.
Ohashi Y, Kobayashi S, Arai T, et al. Focal segmental glomerulosclerosis secondary to juxtaglomerular cell tumor during pregnancy. A case report. Case Rep Nephrol Urol. 2014; 4: 88–94.