Pregnancy and renal outcomes in lupus nephritis: an update and guide to management

Bramham, Kate; Soh, May Ching; Nelson‐Piercy, Catherine

doi:10.1177/0961203312456893

Cited by 57 publications

(27 citation statements)

References 109 publications

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“…This is particularly important in systemic disorders such as systemic lupus erythematosus and vasculitis. It is crucial for those patients with preexisting renal disease to be in remission for 6 months prior to conception to ensure a safe and successful pregnancy [ 3 ]. Treating laboratory test results without corresponding clinical manifestations is unnecessary.…”

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confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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Congenital anomalies occur in 3 % of normal pregnancies [ 1 ]. Therefore, risk assessment of any particular agent during pregnancy needs to take into account this background rate of teratogenicity. For many years, clinicians relied on the FDA risk categories (A, B, C, D, and X) to assess drugs for safety for use in pregnancy. As Briggs, author of the major textbook in this fi eld, points out, these risk assessments are limited because they are "confusing and simplistic" and incorrectly gave the impression that risk increases from category to category [ 2 ]. The FDA is currently considering new labeling for pregnancy risk. The approach this chapter will take is to present the available data on medication safety in pregnancy and lactation and to synthesize the information regarding drug safety.Each pregnant woman has her own view about assuming risk during her pregnancy. For example, some women will avoid any substance that could have potential risk during pregnancy (caffeine, over-the-counter medications, food-additives) while other women will be willing to assume some risk and modify their ingestion of these substances. Similarly, treating physicians have varying tolerance to risk. While one clinician may be willing to prescribe TNF-α blockers during pregnancy, others will be uncomfortable recommending these medications. Therefore, when approaching management decisions of rheumatic diseases during pregnancy, it is helpful for the treating clinician to be aware of both the patient's and their own risk tolerance, in addition to the available medical data. To this end, up-front discussions prior to conception or early in pregnancy regarding what medications may be used safely and comfortably in the case of a disease fl are are ideal.

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confidence: 99%

The Medical Management of the Rheumatology Patient During Pregnancy

Bermas

2014

Contraception and Pregnancy in Patients With Rheumatic Disease

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“…ANA was found to be positive in 92 % patients of SLE in this study. Bramham et al [10] reported that even in the presence of anti-Ro and anti-La antibodies, the incidence of myocarditis is only 2-3 % and increases to 20 % with a prior affected child. In our study, 2 fetuses had CHB diagnosed late in pregnancy, and in both the cases, mothers were found to be positive anti-Ro and anti-La antibodies.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Maternal Autoantibodies with Fetal Congenital Heart Block

Dey

Agarwal

Vijaya

2015

J Obstet Gynecol India

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Background Autoimmune fetal congenital heart block (CHB) is the most severe manifestation of neonatal lupus, and it is seen when maternal autoimmune antibodies cross the placenta and damage the AV node of the fetus. CHB is mainly associated with maternal SLE with anti-Ro/SSAand anti-La/SSB-positive status, and incidence of CHB increases when both the antibodies are present. This study was conducted to know the incidence of fetal CHB in patients of SLE who had ANA, anti-Ro/SSA and anti-La/ SSB positivity. Methods A prospective study was conducted in a tertiarycare teaching hospital of Indian Armed Forces between Jan 2012 to Sep 2014 where 13 cases of SLE were studied. All these patients were tested for ANA, anti-Ro/SSA and antiLa/SSB antibodies and fetal heart abnormalities. Fetuses with CHB were treated with steroids. Results Incidence of SLE was 0.14 %, 92 % of SLE patients were positive for ANA, and 46 % had anti-Ro/ SSA-and anti-La/SSB-positive status. Two fetuses had congenital heart block, and one fetus required pacemaker placement 5 months after delivery. Conclusion All the fetal congenital heart blocks are associated with maternal anti-Ro/SSA and anti-La/SSB and ANA antibodies. Treatment by steroids may improve the outcome in early stages of fetal CHB, and delivery with follow-up should be planned in a tertiary-care center where pacemaker placement facility is available.Dr. Dey Madhusudan MS and Agarwal Raju MD are Reader; Nambula Vijaya MBBS is a Resident

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“…Lupus nephritis seems to be more common in the postpartum period. 16,17 Predictors of poor obstetric outcomes in lupus nephritis include active disease at conception and in early pregnancy, >0.5 g protein/24 hours, CKD stage >3, hypertension and the presence of antiphospholipid antibodies.…”

Section: Lupus Nephritismentioning

confidence: 99%

Renal disease and hypertension in pregnancy

et al. 2013

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-Because women are becoming pregnant at a later age, hypertension is more commonly encountered in pregnancy. In addition, with increasing numbers of young women living with renal transplants and kidney disease, it is important for physicians to be aware of the effects of pregnancy on these diseases. A multidisciplinary approach is essential to assess and care for pregnant women with kidney disease. Pre-pregnancy counselling should be offered to all women with chronic kidney disease. A review of medication to avoid teratogenicity and optimise the disease prior to conception is the ideal. Pregnancy may be the first medical review for a young woman, who may present with a previously undiagnosed renal problem.

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Pregnancy and renal outcomes in lupus nephritis: an update and guide to management

Cited by 57 publications

References 109 publications

The Medical Management of the Rheumatology Patient During Pregnancy

The Medical Management of the Rheumatology Patient During Pregnancy

Correlation of Maternal Autoantibodies with Fetal Congenital Heart Block

Renal disease and hypertension in pregnancy

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