Plasma exchange for nephrotic syndrome in a pregnant woman

A 37-year-old Japanese woman presented with systemic edema at 19 weeks of gestation. She was diagnosed with nephrotic syndrome and treated with 500 mg/day of methylprednisolone at 21 weeks and 4 days of gestation. However, she developed oliguria and her estimated glomerular filtration rate (eGFR) deteriorated to 16.3 mL/min/1.73m2. She was transferred to our hospital, and hemodialysis and plasma exchange were initiated at 22 weeks and 1 days of gestation. Thereafter, her urine volume increased, and hemodialysis and plasma exchange were stopped at 22 weeks and 4 days of gestation. At 23 weeks 3 days of gestation, urine protein and eGFR decreased to 0.13g/gCr and 85.8 mL/min/1.73m2, respectively. She delivered a healthy baby at 38 weeks of gestation. Plasma exchange may be a therapeutic option for pregnant women with severe nephrotic syndrome.