Women with lupus nephritis (LN) who have a complete renal remission prior to pregnancy tend to experience good fetal and maternal outcomes and less LN relapse, a new study finds.
Investigators analyzed the pregnancy outcomes of 158 pregnancies in 155 Chinese patients with LN. Of these, 130 patients had achieved complete renal remission (CRR) and a systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) of 4 or lower prior to pregnancy, and 25 patients had not. CRR was defined as proteinuria less than 0.5 g/24 h, no active urinary sediment, serum albumin 35 g/L or higher, and normal serum creatinine.
The remission group had significantly lower rates of LN relapse (11.3% vs 72.0%), LN relapse in early pregnancy (3.0% vs 44.0%), fetal loss (5.3% vs 20.0%), and premature birth (23.3% vs 48.0%) compared with the control group.
The odds of LN relapse significantly increased 11.2- and 5.2-fold in patients with a pre-pregnancy CRR duration of less than 18 months and anti-C1q antibody positivity, respectively, Weixin Hu, MD, and colleagues from Jinling Hospital, Nanjing University School of Medicine in China, reported in Nephrology Dialysis Transplantation. The odds of fetal loss significantly increased 9.3-fold with anti-phospholipid antibody positivity, and the odds of premature birth significantly increased 3.9-fold with a prednisone dosage of 12.5 mg/d or higher during pregnancy. Age older than 30 years was an independent risk factor for both preeclampsia and premature birth.
Current guidelines for the management of pregnancy in LN patients are mostly based on patients with SLE, but the risk of LN relapse during pregnancy is 2- to 3-fold higher in LN, the investigators noted.
According to Dr Hu’s team, “our study showed that LN patients with complete renal remission for more than 18 months were associated with good pregnancy outcomes and lower LN relapse during pregnancy.”
For immunosuppression during pregnancy, the remission group received prednisone (82.7%), prednisone plus a calcineurin inhibitor (7.5%), or prednisone plus azathioprine (4.5%). Fewer patients in the control group received prednisone alone (28.0%), and more received prednisone plus a calcineurin inhibitor (56.0%) or plus azathioprine (12.0%). Medications contraindicated in pregnancy were discontinued.
Chen Y, Li K, Zhang H, et al. Good pregnancy outcomes in lupus nephritis patients with complete renal remission. Nephrol Dial Transplant. Published online October 5, 2021. doi:10.1093/ndt/gfab289