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Federación Mexicana de Ginecología y Obstetricia, A.C.

2018, Number 07

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Ginecol Obstet Mex 2018; 86 (07)

Lupus nephritis management in pregnancy

Barroso-Domínguez S

Language: Spanish
References: 45
Page: 478-484
PDF size: 239.08 Kb.


ABSTRACT

Background: Systemic lupus erythematosus is a chronic, autoimmune, and multisystemic disease of unknown etiology involving the function of multiple organs and tissues, such as the skin or the kidneys. Renal involvement during pregnancy affects more than 50% of patients, and its presence increases the feto-maternal morbidity and mortality and determines the evolution of pregnancy.
Objective: Describe the right management of lupus nephritis during pregnancy in order to diagnose and prevent the potential complications of these patients.
Clinical case: 36-year-old woman in her second pregnancy with diagnosis of systemic lupus erythematosus with lupus nephritis type IV. She presents a prior pregnancy with progressive deterioration on renal function, that caused the delivery at 37 weeks. The renal biopsy performed three months before conception showed lack of activity and her baseline serum creatinine levels were about 1-4-1.5 mg/dL. During the first trimester she was diagnosed with high blood pressure and due to the progressive deterioration on renal function, with serum creatinine levels up to 2.09 mg/dL the finalization of pregnancy was indicated at 34+3 weeks after fetal lung maturation.
Conclusions: Gestational success of patients with lupus nephritis depends on a good preconceptional planning and a multidisciplinary approach. It is also important the remission of the disease 4-6 months before conception, the degree of renal failure, the presence of high blood pressure and the development of preeclampsia and/ or fetal growth restriction.


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