Effect of pregnancy in patients with lupus nephropathy

Abstract

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 increased 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 attitude towards SLE and treatment modalities used to treat this disease. The data indicate that a history of lupus nephropathy does not preclude an outlook for a successful pregnancy in patients with SLE. Complete clinical remission for at least 6 months indicates a favorable prognosis for an uncomplicated course during pregnancy and a live birth, even in individuals with severe histopathologic changes by renal biopsy and heavy proteinuria in the early stage of their disease. Continued signs of disease activity or renal disease reduce, however, the likelihood for an uncomplicated pregnancy, although persistent proteinuria alone may not represent more of a risk factor than it does in other types of renal disease. The incidence of exacerbation in the present series was not greater postpartum than during pregnancy, as suggested in previous reports. These data indicate, therefore, that generalized conclusions about the prospects of pregnancy should not be made in patients with SLE without consideration of individual features of disease activity and the risk factors suggested by this study.