Lupus Nephritis and Pregnancy

Kontessis, Panayotis; Papageorgiou, Ioannis; Paraskevopoulos, A.; Digenis, George E.; Karaiskakis, Peter T.; Antsaklis, A.; Zerefos, N.

doi:10.3109/10641959809072235

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Our findings concurred with the available literature that showed that SLE flare, APS and hypertension were prognostic factors for poor pregnancy outcomes. 4–12,24–27 SLE flare has been shown to be a predictor for poor pregnancy outcomes in SLE, especially lupus nephritis. 19–21 A meta-analysis of pregnancy outcomes in SLE and lupus nephritis showed that both lupus nephritis and antiphospholipid antibodies increase the risks for maternal hypertension and premature births.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for poor pregnancy outcome, which have been identified from several studies, include hypertension, antiphospholipid syndrome, lupus nephritis, active SLE, thrombocytopenia, hypocomplementemia and presence of lupus anticoagulant. 7–13 The majority of studies were from advanced countries with better health resources and a higher standard of medical care.…”

Section: Introductionmentioning

confidence: 99%

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Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Teh

Wan

Cheong

et al. 2016

Lupus

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We performed a retrospective study of all systemic lupus erythematosus (SLE) pregnancies during a 10-year period (2006–2015) to describe the clinical features, maternal and foetal outcomes in our centre. There were 115 pregnancies in 86 women with SLE. Our patients had a mean age of 29.1 years (SD 5.80) and a mean disease duration of 44.63 months (SD 41.17). Fifteen patients had antiphospholipid syndrome (APS). Our patients had complicated pregnancies: 26.1% had SLE flares, 13.9% had pre-eclampsia and 45.1% needed caesarean sections. There were 23.3% foetal losses and 25% preterm deliveries in our patients. There was a higher rate of unplanned pregnancies and lupus flare among pregnancies with active SLE at conception. Pregnancies in lupus nephritis have higher incidence of lupus flares during pregnancy but similar maternal and foetal outcomes compared to those without nephritis. The prognostic indicators for adverse foetal outcome in our patients were flare of SLE (HR 4.08 [CI 95% 1.65–10.13, p < 0.01]) and APS (HR 3.07 [CI 95% 1.12–8.42, p < 0.05]) and the prognostic indicator for adverse maternal outcome was hypertension (HR 3.58 [CI 95% 1.30–9.90, p < 0.05]). Lupus pregnancies in our centre remained as high-risk pregnancies with significant maternal and foetal complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Teh

Wan

Cheong

et al. 2016

Lupus

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“…Very few biopsies were performed to confirm the diagnosis of lupus nephritis during pregnancy. The majority of papers included patients with both active and inactive SLE at the time of conception; only three papers assessed inactive disease only (6,16,25) and one paper looked at stable disease (15).…”

Section: Study Selection and Demographicsmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis

Smyth¹,

Oliveira²,

Lahr

et al. 2010

Clinical Journal of the American Society of Nephrology

548

450

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Background and objectives: Studies of the impact of systemic lupus erythematosus (SLE) and its pregnancy complications have yielded conflicting results. Major limitations of these studies relate to their small numbers of patients and retrospective designs. The aim of this study was to perform a systematic literature review of pregnancy outcomes in women with SLE and a meta-analysis of the association of lupus nephritis with adverse pregnancy outcomes.Design, setting, participants, & measurements: We searched electronic databases from 1980 to 2009 and reviewed papers with validity criteria. Random-effects analytical methods were used to evaluate pregnancy complications rates.Results: Thirty-seven studies with 1842 patients and 2751 pregnancies were included. Maternal complications included lupus flare (25.6%), hypertension (16.3%), nephritis (16.1%), pre-eclampsia (7.6%), and eclampsia (0.8%). The induced abortion rate was 5.9%, and when excluded, fetal complications included spontaneous abortion (16.0%), stillbirth (3.6%), neonatal deaths (2.5%), and intrauterine growth retardation (12.7%). The unsuccessful pregnancy rate was 23.4%, and the premature birth rate was 39.4%. Meta-regression analysis showed statistically significant positive associations between premature birth rate and active nephritis and increased hypertension rates in subjects with active nephritis or a history of nephritis. History of nephritis was also associated with pre-eclampsia. Anti-phospholipid antibodies were associated with hypertension, premature birth, and an increased rate of induced abortion.Conclusions: In patients with SLE, both lupus nephritis and anti-phospholipid antibodies increase the risks for maternal hypertension and premature births. The presented evidence further supports timing of pregnancy relative to SLE activity and multispecialty care of these patients.

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Lupusnephritis

et al. 2018

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Lupus nephritis (LN) is a common major organ manifestation of systemic lupus erythematosus (SLE) and causes significantly increased morbidity and mortality. Thus, all patients with SLE should be regularly screened for LN. While new onset glomerular hematuria or proteinuria are suggestive for LN, a kidney biopsy is the gold standard for diagnosis and classification. The treatment of LN comprises strict blood pressure control and administration of hydroxychloroquine. Aggressive forms of LN require additional treatment with immunosuppressive induction therapy followed by a maintenance phase for several years. Given the high rate of disease recurrence, life-long follow-up control in specialized centers is necessary. Despite optimal care a significant proportion of patients still develop chronic kidney failure. Better disease activity markers as well as more potent and specific therapeutic agents are thus urgently needed.

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Lupus Nephritis and Pregnancy

Cited by 5 publications

References 18 publications

Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

Systemic lupus erythematosus pregnancies: ten-year data from a single centre in Malaysia

A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis

Lupusnephritis

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