Systemic Lupus Erythematosis Versus IgA Nephropathy with Mild Proteinuria During Pregnancy
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- Category: Vol. 77, June 2009
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Systemic Lupus Erythematosis Versus IgA Nephropathy with Mild Proteinuria During Pregnancy, SAAD ALSHOHOHAIB
Abstract
Objective: To assess the outcome of pregnancies in patients with inactive systemic lupus erythematosus (SLE) compared to IgA nephropathy (IgAN) who has mild proteinuria and normal serum creatinine.
Methods: A prospective study of 32 female patients with a mean age of 28.58±3.55 Vs 27.2±5.58 years for renal vs SLE in King Abdul Aziz University Hospital, in Jeddah, Saudi Arabia was conducted between 1998 and 2008. Before each pregnancy all the patients had their blood pressure, serum creatinine, creatinine clearance and 24-hour urine protein excretion measured. Followed by monthly measurements of blood pressure, serum creatinine, creatinine clearance, a complete blood count (CBC), liver function tests (LFTs) and serology for lupus. All SLE patients had Class IV lupus nephritis and proteinuria of less than 1 g/day, but none of them had renal impairment or hypertension. Statistical analysis for proteinuria measurements during pregnancy was performed using the Wilcoxon signed-rank test. A p value <0.05 was considered statistically significant.
Results: Even though all of the SLE patients reached the third trimester and were antinuclear antibody (ANA) negative, significant complications were observed during pregnancy. The daily proteinuria during 34-36 weeks’ gestation was significantly higher (p<0.05) than during 32 weeks. One had a stillbirth, 2 required a terminations of the pregnancy; 1 due to severe hypertension and 1 due to renal impairment. One patient developed haemolysis and elevated liver enzymes, due to HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome. Two patients had abortions, 14 patients had a successful pregnancy and 4 of them required a caesarian section.
In IgAN group one patient (8.3%) developed hemolysis, elevated liver enzymes and low platelets HELLP syndrome. Two patients, one with preeclampsia and the other with the HELLP syndrome required cesarean section.
Conclusion: Although no clinical evidence of lupus disease activity was demonstrated pre-conception and there was minimal proteinuria, serious complications for both mother and foetus developed as proteinuria significantly increased during pregnancy. SLE is a serious complication during pregnancy. IgAN has also serious complications for both mother and foetus and therefore close monitoring and multi-
disciplinary care are essential during the pregnancy and post-partum period. The study was limited due to the small sample size and meta-analysis is recommended to further investigations in both groups.