Exacerbation of Lupus Nephritis in Pregnant Women with Remission of Lupus Nephritis

Ja Young Jeon; Chang-Hee Suh; Hyoun-Ah Kim; Ju-Yang Jung; JooHo Lee; Eunjung Kang; Hyunee Yim

doi:10.4078/jrd.2013.20.5.314

Journal List > J Rheum Dis > v.20(5) > 1064068

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Jeon, Suh, Kim, Jung, Lee, Kang, and Yim: Exacerbation of Lupus Nephritis in Pregnant Women with Remission of Lupus Nephritis

Case Report

J Rheum Dis 2013;20(5):314-318.

Published online: 31 October 2013

DOI: https://doi.org/10.4078/jrd.2013.20.5.314

Exacerbation of Lupus Nephritis in Pregnant Women with Remission of Lupus Nephritis

Ja Young Jeon¹, Chang-Hee Suh¹, Hyoun-Ah Kim¹, Ju-Yang Jung¹, JooHo Lee¹, Eunjung Kang¹, Hyunee Yim²

¹Department of Rheumatology, Ajou Unversity School of Medicine, Suwon, Korea

²Department of Pathology, Ajou Unversity School of Medicine, Suwon, Korea

Corresponding to : Chang-Hee Suh, Department of Rheumatology, Ajou Unversity School of Medicine, 163, Worldcup-ro, Youngtong-gu, Suwon 443-380, Korea. E-mail : chsuh@ajou.ac.kr

Received 8 August 20125 October 2012 Accepted 6 October 2012

This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that predominantly affects women of re-productive age. Risk of SLE flare during pregnancy is de-pendent on disease activity of SLE and proteinuria at the time of conception, which affect pregnancy outcome. We report on three patients who developed renal flares during pregnancy after remission of lupus nephritis before pregnancy. Two patients were treated successfully, with pregnancy outcomes of live births however, another patient's pregnancy was terminated with induced abortion. For SLE patients, family planningis needed until disease activity of SLE has been stable for at least six months prior to the pregnancy. Nevertheless, flares of lupus could develop and influence maternal and fetal outcome. There-fore, renal flares during pregnancy should be recognized and treated immediately.

Keywords: Systemic lupus erythematosus, Nephritis, Pregnancy, Flare, Abortion

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Table 1.

Clinical and laboratory data of the three pregnant patients with flare of lupus nephritis

	Case 1	Case 2	Case 3
Obstetric history	G2P1L0D0A2^∗	G3P1L0D0A2	G1P1L0D0A0
Anti Ro/La antibody	−/−	+/−	−/−
LAC	−	−	−
ACA (IgM/IgG)	−/−	+/+	+/−
Renal histologic subclass^†	Class V, Class IV+V	Class III	Class II
SLEDAI changes (at 6 months before pregnancy→at conception→at admission)	4→7→18	5→5→8	0→4→4
Interval from remission to pregnancy	8 years	5 years	18 months
Medication during pregnancy	Steroid+HCQ	Aspirin+steroid+HCQ+AZP	Steroid+HCQ
Medication before pregnancy	Steroid+HCQ+AZP	Steroid+HCQ+AZP	Steroid+HCQ
Induction therapy	Steroid+CYC #6, steroid+MMF	Steroid+CYC #6, steroid+MMF	F Steroid+MMF, steroid+MMF

ACA: anticardiolipin antibody, LAC: lupus anticoagulants, SLEDAI: systemic lupus erythematosus disease activity index, AZP: azathioprine, CYC: cyclophosphamide, HCQ: hydroxychloroquine, MMF: mycophenolate mofetil.

^∗ GPLDA: gravid, para, live, death, abortion,

^† Only biopsy-proven results of lupus nephritis were stated.

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