Effect of pregnancy in patients with lupus nephropathy

Abstract

Systemic lupus erythematosus (SLE) occurs primarily in women during child-bearing years. The possible influence of pregnancy on the underlying activity of SLE has important implications for this group of patients because of the threat of severe, and even life threatening, exacerbations of disease, and the possibility of a reduced likelihood of a successful outcome for the product of conception. On the basis of previous reports on large series of cases, the relationship between SLE and pregnancy is controversial [1–4]. Furthermore, although renal involvement is a common feature of SLE and is a major source of morbidity and death [5], the influence of pregnancy on lupus nephropathy has not been ascertained. Previous reports on the relationship between lupus nephropathy and pregnancy are difficult to analyze because, in general, few have detailed information on the chronologic sequence of nephropathy and pregnancy, and the type and severity of the underlying renal histopathologic lesion [1–3, 6–11]. Moreover, in some initial reports, current modes of treatment were not available. The present study was undertaken to characterize the clinical course of SLE in patients with lupus nephropathy during pregnancy and postpartum. Because it seemed unlikely that sufficient clinical materials for analysis would be available to any single clinic, or that a prospective study of pregnancy in patients with SLE would be performed in the near future, we conducted a survey of nephrologists with an interest in lupus nephropathy, representing a wide geographic distribution. This analysis is derived from data obtained on 65 pregnancies by 47 patients with SLE reported from 13 centers. All patients manifested clinical signs of lupus nephropathy at some time during the course of their illness, and renal biopsy material was available in 77% of cases. Because lupus nephropathy increases the morbidity associated with SLE, it seems likely that any bias in selection of these cases would favor those with greater severity. In addition, because these cases were obtained from multiple centers, the clinical material used in this analysis tends to reflect the widely divergent attitudes towards SLE and treatment modalities used to treat this disease.