Lupus nephritis and pregnancy: concerns and management
File(s)
Accepted version
Author(s)
Lightstone, L
Hladunewich, MA
Type
Journal Article
Abstract
Summary: Pregnancy associated with lupus, especially lupus nephritis, is often fraught with concern for both the mother and fetus. Thus, it is paramount that care begins preconception so that proper planning in terms of optimizing the medical regimen, discontinuation of fetotoxic agents, and treatment of active disease can occur. It is well known that active nephritis at the time of conception is associated with poor outcomes. Even with quiescent disease, recent data indicate that being lupus anticoagulant–positive, nonwhite or Hispanic, and using antihypertensive medications were all predictors of worse pregnancy outcomes. Further, prior lupus nephritis also predicts higher rates of preeclampsia and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome. Differentiating lupus nephritis from preeclampsia often presents as a conundrum, but lupus nephritis can be confirmed by the presence of decreasing complement levels and increasing double-stranded DNA (dsDNA) antibody levels in addition to new onset hypertension and proteinuria. We hope that the more mechanistic approach of measuring angiogenic markers, which are diagnostic for preeclampsia, will be the standard of care in the future. Women with lupus and prior lupus nephritis can have successful pregnancies, but outcomes are dependent on “the art of planning” as well as close communication between the obstetrician, the nephrologist, and the rheumatologist.
Date Issued
2017-07-01
Date Acceptance
2017-05-01
Citation
Seminars in Nephrology, 2017, 37 (4), pp.347-353
ISSN
0270-9295
Publisher
Elsevier
Start Page
347
End Page
353
Journal / Book Title
Seminars in Nephrology
Volume
37
Issue
4
Copyright Statement
© 2017 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000406255100006&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Urology & Nephrology
Lupus nephritis
preeclampsia
pregnancy
CARDIAC MANIFESTATIONS
NEONATAL LUPUS
ERYTHEMATOSUS
HYDROXYCHLOROQUINE
MYCOPHENOLATE
PREDICTORS
FETAL
RECOMMENDATIONS
TACROLIMUS
OUTCOMES
Publication Status
Published
Date Publish Online
2017-07-13