A Successful Management of Pregnancy With Lupus Nephritis

Abstract

SLE is a multiorgan autoimmune disease that affects women of childbearing age. The incidence and prevalence of SLE in pregnancy are 1.4-21.9 and 7.4-159.4 per 100,000 people, respectively. 1 It is first diagnosed during pregnancy in 10-30% of the cases. Women with lupus nephritis have a good pregnancy outcome if the disease remains in remission. 2 Active nephritis is associated with higher incidence of maternal complications compared with women without nephritis. 3 Foetal death with active maternal nephritis also increased than in those with quiescent nephritis. Renal involvement in SLE may either be in the form of active lupus nephritis at the time of conception or a new-onset LN or a lupus flare, all have potential maternal, perinatal morbidity and mortality. Here a case of pregnancy with active lupus nephritis of new onset had a good maternal and foetal outcome is reported. KEYWORDSLupus nephritis, Systemic Lupus Erythematosus, Proteinuria, IUGR. INTRODUCTION 26 years old primi with 33 weeks gestation presented to our OPD with a history of swelling of both legs of 2 months and skin rashes over the face, abdomen, both legs, breasts, and skin over the back of 15 days duration. There was no history of headache, vomiting, or decreased urine output. She was booked at a private hospital and at 20 weeks all routine investigations were done including GCT was within normal limits. Target USG was done at 22 weeks and 6 days and congenital anomalies ruled out. She was a known case of hypothyroidism on regular treatment. TSH in first trimester was 6.7 and was put on T. Thyroxine 100 microgram. At 24 weeks, she developed swelling of both legs and skin rashes and at 32 weeks skin lesions were erythematous with crusting and scaling and were not itchy started in the breasts, anterior abdominal wall, anterior chest wall, both legs, and lastly involved the face. It was in the malar region over the face. History of fever, insect bite, and recent drug intake were ruled out. There was no history of joint pain. There was no past history suggestive of any connective tissue disorder. All relevant investigations done and preeclampsia ruled out. The above-mentioned presenting complaints of the patient were suspicious of connective tissue disorder. A thorough clinical examination and relevant investigation were done. The diagnosis of active lupus nephritis of new onset was made as per American College of Rheumatology criteria. HOW TO CITE THIS ARTICLE: