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Treatment of unilateral obstruction reversing heavy and bilateral proteinuria.

Proteinuria is a common ﬁnding in pregnancy andusually attributable to physiological changes that con-currently reduce serum albumin by 5–10g/l. Urinaryprotein loss rarely exceeds 0.4g/day, but nephroticlevels occur in up to 0.025% of all pregnancies [1], evenin the absence of features of pre-eclampsia [2] or renalimpairment. Many patients with pregnancy-associatedproteinuria will remit spontaneously and may be man-aged conservatively without renal biopsy. Non-speciﬁcglomerular lesions may be seen in association withpre-eclampsia [3]. Primary glomerular disease, diabetesand renal vein thrombosis may also produce nephro-tic levels of proteinuria in pregnancy. Pre-existing renaldisease predisposes subjects to develop hypertensionand further accelerated renal decline in pregnancy andthese may be accompanied by an increase in urinaryprotein [4].We present an unusual case where nephroticsyndrome was associated with unilateral uretericobstruction.