Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
Pregnancy in lupus nephritis*,**,*

https://doi.org/10.1053/ajkd.2002.35678Get rights and content

Abstract

Background: Fetal and maternal outcomes of 70 pregnancies in 48 women with lupus nephritis were retrospectively analyzed. Methods: In 13 women, lupus nephritis developed during pregnancy (group A). In 38 patients with known lupus nephritis (including 3 patients in group A who had another pregnancy), 57 pregnancies occurred. In 6 patients, a therapeutic abortion was performed. The remaining 51 pregnancies were considered pregnancies in lupus nephritis (group B). Results: Fetal loss was 36% (38%, group A; 35%, group B); it decreased from 46% in the 1970s to 30% in the last decade. Among 41 live births, there were 13 preterm deliveries and 28 full-term deliveries. At multivariate analysis, proteinuria (P = 0.025), arterial hypertension (P = 0.05), and antiphospholipid antibodies (P = 0.01) were independent predictors of fetal loss. In group A, 3 patients developed acute renal failure, irreversible in 1 patient (7.7%); all other patients recovered after steroid and immunosuppressive therapy. In group B, 12 renal flares and 1 extrarenal flare developed during pregnancy or the postpartum period. Two patients progressed to irreversible renal failure (3.9%), and 1 of the 2 patients died. All other patients recovered. The incidence of renal flares before or during pregnancy was not different (P = 0.51). Renal quiescence at the onset of pregnancy was the only predictor of favorable maternal outcome. Conclusion: Proteinuria, hypertension, and positivity of antiphospholipid antibodies are independent predictors of adverse fetal outcome. Quiescence of renal disease is the only predictor of favorable maternal outcome. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Patients and methods

Between June 1968 and December 2000, a total of 70 pregnancies occurred in 48 women with lupus nephritis followed up in our renal unit. Thirty-five patients had 1 pregnancy, 7 patients had 2 pregnancies, 4 patients had 3 pregnancies, 1 patient had 4 pregnancies, and 1 patient had 5 pregnancies. Pregnancies were subdivided into two groups. Group A included 13 pregnancies in which lupus nephritis developed for the first time during the pregnancy or early postpartum period. Group B included 51

Group A

At the beginning of pregnancy, mean age of the 13 women was 26.8 ± 3.8 years. In 6 patients, a diagnosis of lupus without renal involvement was made 56.2 ± 55.9 months before pregnancy. In all 6 patients, renal function and urine analysis results were normal. Antiphospholipid antibodies were positive in 6 of 11 women tested.

Group B

This group included 51 pregnancies in 38 patients known to have lupus nephritis before pregnancy (Table 1).

. Clinical Characteristics at the Beginning of 51

Discussion

In this study, we retrospectively reviewed all pregnancies observed in the last three decades in patients with lupus nephritis. To the best of our knowledge, this is the largest number of pregnant patients with lupus nephritis followed up in a single unit.

Previous reports showed a fetal loss rate ranging from 8% to 40%.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 In this series, overall fetal loss was 36%. However, these data do not reflect the expected outcome today. Fetal loss decreased from 46% in the

References (23)

  • H Julkunen et al.

    Pregnancy in lupus nephropathy

    Acta Obstet Gynecol Scand

    (1993)
  • Cited by (134)

    • Lupus nephritis

      2019, Nephrology Secrets: Fourth Edition
    • Management of pregnancy and lactation

      2018, Best Practice and Research: Clinical Rheumatology
    • Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study

      2016, Journal of Autoimmunity
      Citation Excerpt :

      Nonetheless, the rate of fetal loss is still higher than in pregnancies of healthy women. Moreover, lupus can complicate pregnancy with an increased risk of stillbirths, premature deliveries, intrauterine growth retardations and heart problems in the newborn [2,5,9,10]. A systematic review of 37 studies, that included 2751 pregnancy outcomes in 1842 women with lupus nephritis, reported an induced abortion rate of 5.9%.

    View all citing articles on Scopus
    *

    Supported by the grant Project Glomerulonephritis in memory of Pippo Neglia.

    **

    Address reprint requests to Gabriella Moroni, MD, Divisione di Nefrologia e Dialisi, Ospedale Maggiore IRCCS, Via della Commenda 15-20122, Milano, Italy. E-mail: [email protected]

    *

    0272-6386/02/4004-0006$35.00/0

    View full text