No abstract

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section.

Acute Kidney Injury (AKI) is associated with increased mortality and morbidity unless timely diagnosed & promptly managed. An understanding of the renal physiologic changes that occur during pregnancy is essential for Proper evaluation, diagnosis, and management of Pregnancy Related AKI (PRAKI). In the general population, AKI can occur from prerenal, intrinsic/renal, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management & prevention of adverse maternal/fetal outcomes. Sometimes PRAKI may require intensive management and even dialysis adding additional economical burden to the patient. We here, with report an interesting case of PRAKI diagnosed & managed in time by simple medical measures thus delivering an effective treatment at a much lesser cost.