Identifying and managing lupus nephritis during pregnancy

ABSTRACT

Introduction: Systemic lupus erythematosus (SLE) is a multi-organ disease that commonly affects women of child bearing-age, and lupus nephritis (LN) represents one of the most severe manifestations. Advances in treatment and better knowledge of the disease have resulted in an increasing number of women seeking pregnancy. Awareness of the relationship of the condition with respect to pregnancy and long-term prognosis is important for all clinicians involved. Presentation of LN can range from mild asymptomatic proteinuria to rapidly progressive renal failure and may occur before, during, or after pregnancy.

Areas covered: Here we detail the evolution of maternal disease, obstetrical and neonatal outcomes. We also report a practical approach to managing these pregnancies before, during and after analysing the predictors of poor obstetrical outcome or kidney worsening. Peculiar condition, as with kidney transplanted mothers, the onset of LN during pregnancy, or independent risk factors are also evaluated.

Expert opinion: The improvement of LN therapies and better knowledge of the relationship has enormously enhanced the chance of uneventful pregnancies for LN women. A crucial step is to carefully plan the pregnancy with analysis of epidemiological, biological and therapeutic aspects that could interfere with the wellbeing of the mother and the child.

KEYWORDS:

• Systemic lupus erythematosus
• pregnancy
• lupus nephritis
• management

Article highlights

• Systemic lupus erythematosus is a multi-organ disease that commonly affects women of child bearing-age, and lupus nephritis (LN) represents one of the most severe manifestations.

• In previous times, women with LN may have been advised against contemplating pregnancy, while nowadays prognosis is much improved.

• However previous or ongoing LN is considered as a major risk factor for the occurrence of obstetrical complications and also for the risk of worsening of renal function.

• Pregnancy in such patients must be followed by a multispecialistic team, and it is recommended that pregnancies should be carefully planned when disease is in remission.

• Pregnancies complicated by LN onset have a particularly severe prognosis and also it could be difficult to differentiate between preeclampsia and flare of LN.

• Additional risks factors as the presence of antiphospholipid antibodies or anti Ro/SSA antibodies must be considered in these pregnancies.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.