Neuraxial Anesthesia in a Patient with Congenital Nephrotic Syndrome and Resultant ESRD Undergoing Cesarean Section

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Congenital nephrotic syndromes (CNS) arise from defects in the structural proteins of the glomerular filtration barrier. When these proteins are nonfunctional, protein escapes into the urine, leading to hypoalbuminemia and a loss of antithrombin III, thereby predisposing the patient to edema and hypercoagulability. The incidence of CNS is estimated to be between 1 and 3 per 100,000 live births. A complication of CNS is the development of end-stage renal disease (ESRD). Guidelines for anticoagulation and hemodialysis (HD) in patients with ESRD are patient-centered, as patients often have varying comorbidities, namely pregnancy. As pregnancy increases hypercoagulability, a pregnant patient who is receiving HD for ESRD and is presenting for cesarean section must have hypercoagulable considerations balanced with anticoagulation administration to safely deliver neuraxial anesthesia.

A 33 YO pregnant woman was transferred to a tertiary care center for preterm labor management at 28 weeks and 2 days of gestation due to major maternal comorbidities, including ESRD, anemia of chronic kidney disease, anti-Jka antibodies, a prior myocardial infarction and cerebrovascular accident related to hyperkalemia, and a prior 20-week intrauterine fetal demise. A transthoracic echocardiogram at hospitalization revealed an LVEF of 70%. Additional history includes Hodgkin's lymphoma, hyperparathyroidism, and antibiotic-associated ototoxicity with bilateral cochlear implants. Prior genetic testing was unrevealing. Pertinent medical history includes CNS, status post bilateral nephrectomies and two failed renal transplants, leading to HD dependence. A transplanted kidney remains in the right pelvis. Before pregnancy, she received HD three times weekly, which increased to six times weekly in pregnancy; her ESRD was stable on weekly Venofer, Mircera every other week, and heparin.

This case highlights the essential features and management of a pregnant patient with ESRD from CNS undergoing neuraxial anesthesia for cesarean section. Coordinated multidisciplinary care is essential for ensuring safe and effective administration of neuraxial anesthesia in a patient with comorbidities that increase the risk for thrombosis.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2052

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