Maryam Kazemi
1 
, Arezoo Harsjian
2 , Azam Moridi
3 , Sadaf Rassouli
4 , Zahra Hamidi Madani
5 , Zeinab Zamanpour
6 , Forouhar Darabi
7 , Roya Biglarifar
8 , Zohreh Sanjarian
9 , Zahra Kamranirad
10 , Sina Salem Ahim
11* 1 Department of Obstetrics and Gynecology, Imam Hossein Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
2 Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Mother and Child Welfare Research Center, Hormozgan University of Medical Science, Bandar Abbas, Iran
4 Department of Gynecology and Obstetrics, Imam Khomeini Hospital, School of Medicine, Sari University of Medical Sciences, Sari, Iran
5 Department of Obstetrics and Gynecology, Reproductive Health Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
6 Department of Gynecology and Obstetrics, School of Medicine, Jundishapur University of Medical Sciences, Ahvaz, Iran
7 Department of Gynecology and Obstetrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
8 Department of Obstetrics and Gynecology, School of Medicine, Iran University of Medical Sciences: Tehran, Iran
9 Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
10 Department of Gynecology and Obstetrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
11 General Medicine, Fasa University of Medical Sciences, Fasa, Iran
Abstract
Antiphospholipid antibody (aPL) nephropathy in pregnancy is a critical and complex medical condition that poses significant risks to both maternal renal health and fetal development. This autoimmune disorder is characterized by the presence of aPLs, which target phospholipid-binding proteins, leading to a procoagulant state. In the context of pregnancy, this predisposition to thrombosis can manifest as thrombotic microangiopathy (TMA) within the renal vasculature, directly impacting kidney function. The resulting renal microvascular injury contributes to a decline in maternal renal health, potentially leading to proteinuria, hypertension, and even acute kidney injury, exacerbating the already delicate physiological changes of pregnancy. The intricate interplay between autoimmune-mediated thrombosis and placental dysfunction is central to the high-risk nature of this condition. aPLs can cause thrombosis in the placental vasculature, leading to placental insufficiency, intrauterine growth restriction, preeclampsia, and recurrent pregnancy loss. This compromise in placental blood flow not only jeopardizes fetal development but also indirectly strains maternal renal function. The systemic inflammation and endothelial dysfunction associated with aPLs further complicate the clinical picture, making accurate diagnosis and timely intervention paramount for managing these multifaceted challenges. Effective management of aPL nephropathy in pregnancy necessitates a highly individualized and multidisciplinary approach, focusing on meticulous monitoring of both maternal and fetal well-being. This includes close surveillance of renal function, blood pressure, and proteinuria, alongside regular assessments of fetal growth and placental health. Therapeutic strategies often involve anticoagulation with heparin, sometimes combined with low-dose aspirin, to mitigate the thrombotic risk. Such precise monitoring and tailored interventions are crucial for optimizing outcomes, aiming to preserve maternal renal health while supporting successful fetal development in this challenging clinical scenario.
Implication for health policy/practice/research/medical education:
Antiphospholipid antibody nephropathy (APLN) in pregnancy represents a high-risk condition with profound implications for maternal renal health and fetal development. The interplay between autoimmune-mediated thrombosis, placental dysfunction, and renal microvascular injury creates a complex clinical picture that demands exact monitoring and individualized care.
Please cite this paper as: Kazemi M, Harsjian A, Moridi A, Rassouli S, Hamidi Madani Z, Zamanpour Z, Darabi F, Biglarifar R, Sanjarian Z, Kamranirad Z, Salem Ahim S. Antiphospholipid antibody nephropathy in pregnancy; consequences for fetal renal development and maternal health outcomes. J Nephropathol. 2026;15(2):e27691. DOI: 10.34172/jnp.2026.27691.