J Rheum Dis.  2013 Oct;20(5):314-318. 10.4078/jrd.2013.20.5.314.

Exacerbation of Lupus Nephritis in Pregnant Women with Remission of Lupus Nephritis

• Jeon JY
• Suh CH
• Kim HA
• Jung JY
• Lee J
• Kang E
• Yim H

• KMID: 2223008
• DOI: http://doi.org/10.4078/jrd.2013.20.5.314

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that predominantly affects women of reproductive age. Risk of SLE flare during pregnancy is dependent on disease activity of SLE and proteinuria at the time of conception, which affect pregnancy outcome. We report on three patients who developed renal flares during pregnancy after remission of lupus nephritis before pregnancy. Two patients were treated successfully, with pregnancy outcomes of live births however, another patient's pregnancy was terminated with induced abortion. For SLE patients, family planningis needed until disease activity of SLE has been stable for at least six months prior to the pregnancy. Nevertheless, flares of lupus could develop and influence maternal and fetal outcome. Therefore, renal flares during pregnancy should be recognized and treated immediately.

Keyword

Systemic lupus erythematosus; Nephritis; Pregnancy; Flare; Abortion

MeSH Terms

Abortion, Induced
Female
Fertilization
Humans
Live Birth
Lupus Erythematosus, Systemic
Lupus Nephritis*
Nephritis
Pregnancy
Pregnancy Outcome
Pregnant Women*
Proteinuria

Reference

References

1. Hayslett JP. Maternal and fetal complications in pregnant women with systemic lupus erythematosus. Am J Kidney Dis. 1991; 17:123–6.

2. Doria A, Tincani A, Lockshin M. Challenges of lupus pregnancies. Rheumatology (Oxford). 2008; 47(Suppl 3):iii9–12.

3. Smyth A, Oliveira GH, Lahr BD, Bailey KR, Norby SM, Garovic VD. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol. 2010; 5:2060–8.

4. Bramham K, Hunt BJ, Bewley S, Germain S, Calatayud I, Khamashta MA, et al. Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis. J Rheumatol. 2011; 38:1906–13.

5. Aggarwal N, Raveendran A, Suri V, Chopra S, Sikka P, Sharma A. Pregnancy outcome in systemic lupus erythematosus: Asia's largest single centre study. Arch Gynecol Obstet. 2011; 284:281–5.

6. Imbasciati E, Tincani A, Gregorini G, Doria A, Moroni G, Cabiddu G, et al. Pregnancy in women with pre-existing lupus nephritis: predictors of fetal and maternal outcome. Nephrol Dial Transplant. 2009; 24:519–25.

7. Kwok LW, Tam LS, Zhu T, Leung YY, Li E. Predictors of maternal and fetal outcomes in pregnancies of patients with systemic lupus erythematosus. Lupus. 2011; 20:829–36.

8. Khamashta MA. Systemic lupus erythematosus and pregnancy. Best Pract Res Clin Rheumatol. 2006; 20:685–94.

9. Moroni G, Ponticelli C. Pregnancy after lupus nephritis. Lupus. 2005; 14:89–94.

10. Buyon JP, Cronstein BN, Morris M, Tanner M, Weissmann G. Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia. Am J Med. 1986; 81:194–200.

11. Clowse ME, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. J Rheumatol. 2011; 38:1012–6.

12. Petri M, Allbritton J. Fetal outcome of lupus pregnancy: a retrospective case-control study of the Hopkins Lupus Cohort. J Rheumatol. 1993; 20:650–6.

13. Clowse ME, Magder L, Witter F, Petri M. Hydroxychlor-oquine in lupus pregnancy. Arthritis Rheum. 2006; 54:3640–7.

14. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005; 330:565.

15. Mak A, Cheak AA, Tan JY, Su HC, Ho RC, Lau CS. Mycophenolate mofetil is as efficacious as, but safer than, cyclophosphamide in the treatment of proliferative lupus nephritis: a meta-analysis and meta-regression. Rheumatology (Oxford). 2009; 48:944–52.