Pregnancy in women with Alport syndrome

Little is known about pregnancy in women with Alport syndrome (AS), as only four cases have been reported in the literature. We herein describe the course of pregnancy in two sisters with overt forms of AS. Both women were diagnosed as having autosomal recessive AS. Before pregnancy, their renal function and their blood pressure were normal, and proteinuria values were below 2 g/24 h. Both patients faced a progressive and remarkable increase in proteinuria during pregnancy, with subsequent hypoproteinemia. The clinical condition worsened, particularly in the first case, who was managed with some success with a combination of diuretics. She delivered at 32 weeks of pregnancy. The second patient was less challenging and she delivered at 36 weeks. Proteinuria returned to pre-pregnancy levels in both cases, after delivery. Management of pregnant women with overt AS is challenging and worsening of renal disease has to be expected. The use of diuretic therapy may be of benefit.