The effect of pregnancy on the long-term renal function in lupus nephritis patients

Abstract

Pregnancy is an important consideration in the treatment of patients with lupus nephritis(LN), particularly because the disease predominantly affects females of childbearing age. Forty-two patients were studied retrospectively to investigate whether delivery adversely affects the natural course of renal function in patients with LN. The patients were divided into two groups(patients with delivery during the follow-up period: Group I, n = 11; patients who were not pregnant: Group II, n = 28; excluding 3 patients with abortion). Group I and II profiles at the beginning of the follow-up were as follows: age(years): 26.7 +/- 5.0(mean +/- SD) and 30.5 +/- 8.4; S-Cr(mg/dl): 0.86 +/- 0.27 and 1.05 +/- 0.52, respectively; urinary protein(g/day): 2.42 +/- 3.05 and 3.37 +/- 4.08; follow-up period(months): 144 +/- 65.2 and 98.7 +/- 68.0; WHO IV LN was 27%(3/11) in Group I and 61%(17/28) in Group II. The activity of SLE in Group I disappeared before gestation, except for one case, and no patients experienced recurrence during pregnancy or after delivery. Delivery did not adversely affect the long-term prognosis of renal function in the three patients with WHO IV LN in Group I. The changes in the renal function between Groups I and II during the follow-up period were not significantly different (delta 1/Cr/dl/mg/months: -0.00066 +/- 0.00356 in Group I, 0.00636 +/- 0.02889 in Group II). Renal deterioration was observed in only one case (9%) in Group I (the patient had persistent proteinuria of over 2 g/day throughout the clinical course and started hemodialysis 12 years after delivery), and in 3 cases(11%) in Group II at the end of follow-up. The renal survival rate did not significantly differ between the two groups. We concluded that delivery does not adversely affect the long-term prognosis of patients with LN that is clinically controlled through treatment.