A roller coaster journey of pregnancy with lupus nephritis
Pregnancy with Lupus Nephritis
Keywords:
Lupus Nephritis, Pre-Eclampsia, Prednisolone, Azathioprine, fetal growth retardationAbstract
Systemic lupus erythematosus (SLE) is an autoimmune disease, that primarily affects young females. In SLE patients, pregnancy remains a perilous situation affecting both maternal and foetal outcomes. The biggest issue is the 3-5 times higher risk of preeclampsia, complicating 16-30% of SLE pregnancies. In SLE, additional specific risk factors include active or history of lupus nephritis, anti-phospholipid antibodies, declining complement levels, and thrombocytopenia. The purpose of this case report is to have a glimpse into the odyssey of a woman from the commencement of developing lupus to successfully attaining motherhood which is a parity score of 2 with a living second child and loss of a first child. Frequent monitoring is needed to revise treatment strategy at every visit with a holistic multidisciplinary approach for better foetal & maternal outcomes.
References
Kale A, Güzel A İrfan, Erdemoğlu M, Kuyumcuoğlu U, Akdeniz N, Kangal K. Lupus Nephritis and Pregnancy: Case Report. Gynecol Obstet Reprod Med [Internet], 2009; 15(2):111-2. Available from: https://gorm.com.tr/index.php/GORM/article/view/415
Petri M. Hopkins Lupus Pregnancy Center: 1987 to 1996. Rheum Dis Clin North Am, 1997; 23(1):1-13. doi: 10.1016/s0889-857x(05)70311-2. PMID: 9031371.
Rahman P, Gladman DD, Urowitz MB. Clinical predictors of fetal outcome in systemic lupus erythematosus. J Rheumatol, 1998; 25(8):1526-30. PMID: 9712095.
Gladman DD, Tandon A, Ibañez D, Urowitz MB. The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications. J Rheumatol, 2010; 37(4):754-8. doi: 10.3899/jrheum.090872. Epub 2010 Mar 15. PMID: 20231194.
Clowse ME, Magder L, Witter F, Petri M. Hydroxychloroquine in lupus pregnancy. Arthritis Rheum, 2006; 54(11):3640-7. doi: 10.1002/art.22159. PMID: 17075810.
Clowse ME, Magder LS, Witter F, Petri M. The impact of increased lupus activity on obstetric outcomes. Arthritis Rheum, 2005; 52(2):514-21. doi: 10.1002/art.20864. PMID: 15692988.
Saavedra MA, Cruz-Reyes C, Vera-Lastra O, Romero GT, Cruz-Cruz P, Arias-Flores R, et al. Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy. Clin Rheumatol, 2012; 31(5):813-9. doi: 10.1007/s10067-012-1941-4. Epub 2012 Jan 27. PMID: 22278163.
Stagnaro-Green A, Akhter E, Yim C, Davies TF, Magder L, Petri M. Thyroid disease in pregnant women with systemic lupus erythematosus: increased preterm delivery. Lupus, 2011; 20(7):690-9. doi: 10.1177/0961203310394894. Epub 2011 Mar 24. PMID: 21436215.
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(9):1906-13. doi: 10.3899/jrheum.100997. Epub 2011 Jun 1. PMID: 21632681.
Chakravarty EF, Colón I, Langen ES, Nix DA, El-Sayed YY, Genovese MC, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. Am J Obstet Gynecol, 2005; 192(6):1897-904. doi: 10.1016/j.ajog.2005.02.063. PMID: 15970846.
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(8):829-36. doi: 10.1177/0961203310397967. Epub 2011 May 4. PMID: 21543513.
Egerman RS, Ramsey RD, Kao LW, Bringman JJ, Bush AJ, Wan JY. Hypertensive disease in pregnancies complicated by systemic lupus erythematosus. Am J Obstet Gynecol, 2005; 193(5):1676-9. doi: 10.1016/j.ajog.2005.03.073. PMID: 16260209.
Fischer-Betz R, Specker C, Brinks R, Aringer M, Schneider M. Low risk of renal flares and negative outcomes in women with lupus nephritis conceiving after switching from mycophenolate mofetil to azathioprine. Rheumatology (Oxford), 2013; 52(6):1070-6. doi: 10.1093/rheumatology/kes425. Epub 2013 Feb 4. PMID: 23382355.
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol, 2017; 216(2):110-120.e6. doi: 10.1016/j.ajog.2016.09.076. Epub 2016 Sep 15. PMID: 27640943.
Tarr T, Lakos G, Bhattoa HP, Shoenfeld Y, Szegedi G, Kiss E. Analysis of risk factors for the development of thrombotic complications in antiphospholipid antibody positive lupus patients. Lupus, 2007; 16(1):39-45. doi: 10.1177/0961203306074767. PMID: 17283584.
Tektonidou MG, Laskari K, Panagiotakos DB, Moutsopoulos HM. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum, 2009; 61(1):29-36. doi: 10.1002/art.24232. PMID: 19116963.
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Copyright (c) 2022 Dr. Vinita Singh, Dr. Akanksha Mishra, Dr. Pragati Trigunait, Dr. Zamir Lone, Dr. Pushpawati Thakur
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