Renal biopsy in pregnancies complicated by undetermined renal disease

Chen, Han‐Hsiang; Lin, Hsin-Chang; Yeh, Jen-Chieh; Chen, Chie-Pein

doi:10.1080/791200642

Cited by 51 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The risks and benefits of biopsy versus delivery should be considered with the obstetrical and neonatal providers. Although early studies reported high complication rates, including gross hematuria in 16.7% and perirenal hematoma in 4.4% (61), more recent series report similar complication rates to nonpregnant women (62,63).…”

Section: Antepartum Managementmentioning

confidence: 97%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Summary SLE is a multi-organ autoimmune disease that affects women of childbearing age. Renal involvement in the form of either active lupus nephritis (LN) at the time of conception, or a LN new onset or flare during pregnancy increases the risks of preterm delivery, pre-eclampsia, maternal mortality, fetal/neonatal demise, and intrauterine growth restriction. Consequently, current recommendations advise that the affected woman achieve a stable remission of her renal disease for at least 6 months before conception. Hormonal and immune system changes in pregnancy may affect disease activity and progression, and published evidence suggests that there is an increased risk for a LN flare during pregnancy. The major goal of immunosuppressive therapy in pregnancy is control of disease activity with medications that are relatively safe for a growing fetus. Therefore, the use of mycophenolate mofetil, due to increasing evidence supporting its teratogenicity, is contraindicated during pregnancy. Worsening proteinuria, which commonly occurs in proteinuric renal diseases toward the end of pregnancy, should be differentiated from a LN flare and/or preeclampsia, a pregnancy-specific condition clinically characterized by hypertension and proteinuria. These considerations present challenges that underscore the importance of a multidisciplinary team approach when caring for these patients, including a nephrologist, rheumatologist, and obstetrician who have experience with these pregnancyrelated complications. This review discusses the pathogenesis, maternal and fetal risks, and management pertinent to SLE patients with new onset or a history of LN predating pregnancy.

show abstract

Section: Antepartum Managementmentioning

confidence: 97%

Obstetric Nephrology

Stanhope

White

Moder

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Complement-split products, such as C3a, may also indicate a flare, but their measurement is not routinely available. A renal biopsy may be needed to define the presence of active lupus glomerulonephritis [63]; however, the increased risk of bleeding following such biopsies in pregnancy is a consideration. On occasion, this diagnostic dilemma demands resolution with delivery of the fetus or a trial of empiric therapy.…”

Section: Reviewmentioning

confidence: 99%

Flares of systemic lupus erythematosus during pregnancy and the puerperium: prevention, diagnosis and management

Stojan

Baer²

2012

Expert Review of Clinical Immunology

View full text Add to dashboard Cite

“…Complication rates in these studies ranged from perirenal hematoma rates of 0 -40%, with up to 25% of those cases requiring transfusion, and there were no maternal deaths (24,25). These recent studies substantiate Lindheimer and Davidson's suggestion that renal biopsy has a role in pregnancy and that the invasiveness of the procedure should be factored into the decision whether to biopsy.…”

Section: General Diagnostic Principlesmentioning

confidence: 54%