Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Krane, N. Kevin; Thakur, Vikram; Wood, Harrison F.; Meleg-Smith, Suzanne

doi:10.1159/000168848

Cited by 14 publications

(6 citation statements)

References 18 publications

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“…An absolute differentiation of preeclampsia from the activation of lupus nephritis is, however, impossible and, theoretically, these two conditions can occur together. Renal biopsies are seldom performed during pregnancy, although they could provide an accurate histopathological diagnosis and lead to appropriate therapy ( 14 ).…”

Section: Pre-eclampsia or Active Lupus Nephritis?mentioning

confidence: 99%

Renal lupus in pregnancy

Julkunen

1998

Scandinavian Journal of Rheumatology

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Section: Pre-eclampsia or Active Lupus Nephritis?mentioning

confidence: 99%

Renal lupus in pregnancy

Julkunen

1998

Scandinavian Journal of Rheumatology

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“…The findings were diagnostic of glomerulopathy due to preeclampsia. 41,42 There was no evidence of lupus nephritis or any other form of renal disease.…”

Section: Pathological Discussionmentioning

confidence: 97%

Case 30-1998

Ludmir¹,

Smith²

1998

N Engl J Med

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A 30-year-old woman (gravida 2, para 0) was admitted to the hospital at 27 weeks' gestation because of increasing hypertension and proteinuria.The patient had been well until 10 years earlier, when polyarthralgia developed. Nine years before admission, the patient's right first toe became painful and cyanotic. The results of laboratory tests performed at that time and subsequently are shown in Tables 1, 2, 3, and 4. A percutaneous angiographic examination showed thromboemboli in the right peroneal and anterior tibial arteries. No thrombotic tendency or embolic source was discovered, although the patient had taken a combination of levonorgestrel and ethinyl estradiol until an unknown point in time before the onset of symptoms. She took warfarin for the next six months, and there was no further evidence of thromboembolism.Eight years before admission, the patient was evaluated elsewhere for a febrile illness. The prothrombin and partial-thromboplastin times were normal. Hypertension and active renal disease developed, and she took enalapril for a year. Seven years before admission, she was hospitalized because of symptoms of systemic lupus erythematosus. A percutaneous renal biopsy showed glomerulonephritis with diffuse mesangial expansion and proliferation and subendothelial and mesangial electron-dense deposits -findings consistent with a diagnosis of systemic lupus erythematosus. The disease responded to treatment with azathioprine and prednisone. Six years before admission, all medications were discontinued. Thereafter, the patient was well, with normal urine and normal renal function.One year before admission, the patient had a spontaneous abortion during the 12th week of ges-T ABLE 1. U RINARY L ABORATORY F INDINGS .

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“…2,3,10,11 Over the past 20 years, however, only one study has specifically addressed the role of renal biopsy in lupus nephritis during pregnancy. 12 In this case series by Krane et al, three women underwent a renal biopsy while pregnant. All were found to have diffuse proliferative lupus nephritis and subsequent management was guided by information gained from renal biopsy.…”

Section: Introductionmentioning

confidence: 93%

“…All were found to have diffuse proliferative lupus nephritis and subsequent management was guided by information gained from renal biopsy. 12 We describe 11 women with SLE who underwent a renal biopsy during pregnancy for further evaluation of possible active renal involvement. We also outline our approach to renal biopsy in the pregnant patient with SLE.…”

Section: Introductionmentioning

confidence: 99%

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Renal biopsy in the management of lupus nephritis during pregnancy

Chen¹,

Gelber

Witter

et al. 2014

Lupus

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The differential diagnosis of proteinuria and hematuria in pregnancy is broad and includes active lupus nephritis. Identification of the correct diagnosis often has a profound therapeutic impact on not only the mother but also the fetus. To date, relatively few reports exist on the role of renal biopsy during pregnancy among women with systemic lupus erythematosus (SLE). We present a case series of 11 pregnant women with SLE who underwent a renal biopsy to evaluate a presumptive flare of lupus nephritis. The electronic medical record was retrospectively analyzed for pre-biopsy serum creatinine, proteinuria, hematuria, antinuclear antibodies (ANA), and antibodies to double-stranded DNA (anti-dsDNA); histologic findings on renal biopsy; and the clinical course of each mother and fetus. From 2001 to 2012, 11 pregnant women with SLE flares during pregnancy underwent a renal biopsy at an academic tertiary medical center. At the time of biopsy, median gestational age was 16 weeks (range 9 to 27), median serum creatinine was 0.6 mg/dl (interquartile range 0.5 to 0.9), six (55%) had hematuria, and all had proteinuria >500 mg/24 hours. Proliferative lupus nephritis was found in 10 (91%) of 11 biopsies (five with ISN/RPS Class III; five with ISN/RPS Class IV). All but one individual underwent a change in management guided by information gleaned from renal biopsy. No apparent biopsy-related complications occurred to mother or fetus. Three women elected to terminate their pregnancy; although many factors were involved, the findings on renal biopsy informed the decision-making process. Among the remaining cases, there were three pre-term deliveries, one fetus with complete heart block, one in utero demise, and one maternal death. Renal biopsy is helpful at informing the management of patients with lupus nephritis during pregnancy.

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Evaluation of Lupus Nephritis during Pregnancy by Renal Biopsy

Cited by 14 publications

References 18 publications

Renal lupus in pregnancy

Renal lupus in pregnancy

Case 30-1998

Renal biopsy in the management of lupus nephritis during pregnancy

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