Pregnancy with lupus nephritis: a case report

2017 ◽  
Vol 6 (3) ◽  
pp. 1127 ◽  
Author(s):  
Vineet Mishra ◽  
Sugandha Goel ◽  
Himani Aggarwal ◽  
Sumesh Choudhary
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Fetal Loss ◽  
Connective Tissue Disorder ◽  
Childbearing Age ◽  
Disease Symptoms ◽  
Optimal Outcomes ◽  
Uterine Growth ◽  
Intra Uterine Growth Restriction ◽  
Neonatal Monitoring

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that commonly affects women of childbearing age. Lupus nephritis in pregnancy increases risk of maternal and fetal morbidity and mortality. Active disease during pregnancy and disease flares can lead to poor outcome. Higher rates of fetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes, gestational diabetes, osteoporosis, avascular necrosis, hypertension, preeclampsia, ecclampsia, stroke, HELLP syndrome, and maternal death are major issues. There is difficulty in recognizing disease flare because of normal physiological changes during pregnancy. Preeclampsia mimics disease symptoms of lupus nephritis and presents confusion in diagnosis. Management option is limited to few safer drugs. Lupus nephritis with antiphospholipid antibodies presents with refractory fetal loss and complete heart block associated with anti-Ro antibodies. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. Our aim is to report a case of primigravida 37 years old with controlled lupus nephritis.

Frequency of Histopathological patterns of Lupus Nephritis according to classification by WHO among Pakistani patients

2021 ◽  
Vol 15 (9) ◽  
pp. 2343-2344
Author(s):  
Aijaz Z. Khan Chachar ◽  
Miqdad Haider ◽  
Naveed A. Lashari ◽  
M. Mueed Yasin ◽  
Hafiz B. A. Kalhoro ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Biopsy ◽  
Lupus Erythematosus ◽  
Who Classification ◽  
Correct Diagnosis ◽  
Class Ii ◽  
Class Iii ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Cross Sectional

Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder, multisystemic in nature more common in females of childbearing age. There are certain risk factors which predispose to this disease. It affects various organs, kidney is among them. Almost 60% patients having SLE ultimately leads to kidney dysfunction at some stage of the life. Aim: To find out pattern of histopathological findings of lupus nephritis as per WHO classification on kidney biopsy in Pakistan. Methodology: This cross-sectional study was completed in department of Medicine, Fatima Memorial Hospital, Lahore, from March 2016 to May, 2018. Total sample size was 165 patients. Only patients who fulfilled the 2012 SLICC (Systemic Lupus International Collaborating Clinics) criteria were included in the study. SPSS version 25.0 was used data analysis. Results: Age of the patients was between 31-50 years i.e. 114(69.09%), mean and SD was 43.96±4.84 years, females were more commonly affected by calculating 99(59.70%). Patterns of lupus nephritis as per WHO classification and renal biopsy were noted which shows 18(10.91%) had Class I, 53(32.12%) Class II, 43(26.07%) Class III, 35(21.20%) Class IV, 10(6.06%) Class V and 6(3.64%) had Class VI. Conclusion: Class II and Class III Lupus Nephritis are the most common modalities found in patients of SLE. Every patient with Lupus Nephritis should undergo a Renal Biopsy for correct diagnosis of the class of this disease and further management accordingly. Keywords: Lupus Nephritis, SLE, renal biopsy

Lupus Nephritis diagnosed by stand-alone renal histopathological findings in a middle-aged male.

JMS SKIMS ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 41-44
Author(s):  
Rayees Yousuf Sheikh ◽  
Nucksheeba Aziz Bhat ◽  
Rajat Mangal ◽  
Alok Sharma
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
High Sensitivity ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Histopathological Findings ◽  
Nuclear Antigens ◽  
Autoimmune Condition

Systemic lupus erythematosus (SLE) is a systemic autoimmune condition, characterized by the production of autoantibodies, predominantly against nuclear antigens. It primarily affects women of childbearing age. Men account for 4-22% of all cases in various series (1,2). Lupus nephritis can be diagnosed with high sensitivity and specificity based on histopathological criteria alone (3). We report lupus nephritis in a 50-year-old male diagnosed solely on renal histopathological findings.

scholarly journals Sysyemic Lupus Erythematosus with Multiple Organ Damage

2020 ◽  
Vol 17 (5) ◽  
pp. 63-73
Author(s):  
Andreea Alexandra Nicola ◽  
Mădălina Dună ◽  
Ioana Miler ◽  
Nicoleta Petre ◽  
Denisa Predeţeanu
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Clinical Manifestations ◽  
Organ Damage ◽  
Multiple Organ ◽  
Alveolar Haemorrhage ◽  
Interdisciplinary Management ◽  
Childbearing Age ◽  
Pulmonary Infarction ◽  
Pulmonary Manifestations

Abstract Systemic lupus erythematosus (SLE) is a heterogeneous rheumatic disease with various clinical manifestations and a multifactorial pathogenesis. Although the etiology of SLE is unknown, certain risk factors have been identified as promoters of an imbalance in the immune system with antibody formation and tissue damage secondary to the deposition of immune complexes. Women of childbearing age are predominantly affected, regardless of ethnicity. SLE affects the kidneys in about 50% of patients, lupus nephritis (LN) being a major risk factor for overall morbidity and mortality. The lungs are commonly involved later in the course of the disease, pulmonary involvement in SLE being extremely varied. It includes along with pleuritis which is the most common manifestation, acute lupus pneumonitis, pulmonary vasculitis, pulmonary embolism, diffuse alveolar haemorrhage; opportunistic pulmonary infections or drug toxicity could be other pulmonary manifestations. We present the case of a young woman with SLE complicated with lupus nephritis class V and pulmonary infarction due to thromobosis of a pulmonary artery. It is a case of SLE with multiple organ damage and life-threatening complications that require interdisciplinary management and appropriate treatment.

Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus

2017 ◽  
Vol 9 (2) ◽  
pp. 134-136
Author(s):  
Leelavathi Basava ◽  
K Triveni ◽  
G Sindhu Sree
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Pregnancy Outcome ◽  
Lupus Erythematosus ◽  
Immunosuppressive Agents ◽  
Fetal Loss ◽  
Therapeutic Interventions ◽  
Elective Cesarean Section ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Successful Pregnancy

ABSTRACT Systemic lupus erythematosus (SLE) is an autoimmune disease most frequently found in women of childbearing age and may coexist with pregnancy. Disease exacerbation, increased fetal loss, neonatal lupus, and an increased incidence of preeclampsia are the major challenges. Its multisystem involvement and therapeutic interventions like anticoagulants, steroids, and immunosuppressive agents pose a high risk for both the mother and the fetus during the antenatal period as well as postpartum. Good multidisciplinary medical care is mandatory when detection or flare-up of SLE occurs during pregnancy. We describe the successful management of an antinuclear antibody, antiribonucleoprotein antibody, and anti-Sjogren's syndrome A (Ro) antibody positive parturient with bad obstetric history who underwent elective cesarean section and delivered a healthy child. How to cite this article Basava L, Roy P, Triveni K, Sree GS. Successful Pregnancy Outcome in a Case of Systemic Lupus Erythematosus. J South Asian Feder Obst Gynae 2017;9(2): 128-130.

Characteristics of lupus nephritis in Saudi lupus patients: A retrospective observational study

Lupus ◽  
2020 ◽  
Vol 29 (12) ◽  
pp. 1638-1643
Author(s):  
Majed R Albirdisi ◽  
Ibrahim A Al-Homood
Keyword(s):  
Saudi Arabia ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Laboratory Findings ◽  
Medical City ◽  
Systemic Disorder ◽  
End Stage

Objectives Systemic lupus erythematosus (SLE) is a chronic autoimmune multi-systemic disorder of the connective tissue, characterized mainly by involvement of the skin, joints, kidneys, and serosal membranes. It affects females particularly at childbearing age more commonly than males. Lupus nephritis affects around half of patients with SLE. Data about SLE and lupus nephritis in Saudi Arabia are still scarce. In this study, we aimed to evaluate the prevalence, clinical and laboratory findings of SLE and different histological types of lupus nephritis among Saudi patients at King Fahad Medical City. Methods This is a retrospective study for adult patients who have been evaluated at king Fahad medical city between 2014 and 2019 and fulfilled the Systemic Lupus International Collaborating Clinics classification criteria (SLICC). Results 112 patients, 103 (92%) females and 9 (8%) males, with confirmed diagnoses of SLE were reviewed. Skin rash (69.6%), photosensitivity (61.6%), mucosal ulcerations (45.9%), arthralgia and/or arthritis (44.6%) are the most common clinical features. Ninety seven (86.6%) out of 112 patients had a recorded first visit 24 hour urine protein level, out of those only 26 (23.2) patients presented with significant proteinuria of more than 0.5grams per day. Forty four (39.2%) have undergone kidney biopsy. Class IV and III lupus nephritis are the most common reported biopsy results (43.18% and 27.28% respectively). During the study period, three patients (2.7%) developed end-stage kidney disease requiring dialysis and five (4.5%) had renal transplant. Conclusion Our study provided insight on the demographics, characteristics and presentation of SLE patients and the outcome of lupus nephritis in Saudi Arabia.

scholarly journals Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

2016 ◽  
Vol 6 (1) ◽  
pp. 329
Author(s):  
Kaliki Hymavathi Reddy ◽  
Kolla Praveen Kumar ◽  
Surekha Tadisetti ◽  
Divya Pusarla
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Interesting Case ◽  
Medical Community ◽  
Medical Illness ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Childbearing Age ◽  
Successful Pregnancy ◽  
Pregnancy And Delivery

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.

scholarly journals EP16 Challenges in treating new onset systemic lupus erythematosus with lupus nephritis and COVID-19 infection overlap

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Selma Dahou ◽  
Tim Leach ◽  
Kathryn Bostock ◽  
Jonathan Louden ◽  
Jonathan Raj ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Lupus Nephritis ◽  
Immunosuppressive Therapy ◽  
Lupus Erythematosus ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Suitable Alternative ◽  
Increased Risk ◽  
History Of

Abstract Case report - Introduction COVID-19 infection caused by a novel coronavirus SARS-coV-2 has made the diagnosis and the treatment of inflammatory diseases incredibly challenging. On the one hand, because of its pro-inflammatory state, that may aggravate or trigger flares in autoimmune diseases such as systemic lupus erythematosus (SLE). On the other hand, the risk of an immunosuppressive therapy during the active phase SARS-coV-2 infection that may lead to catastrophic outcomes. We report a case of a 24-year-old female newly diagnosed with SLE during COVID-19 pandemic who developed COVID-19 infection during her induction treatment for lupus nephritis. Case report - Case description A 24-year-old Nepali female, with no past medical history of note, presented to her regional hospital with a history of flu-like symptoms few days ago, peripheral oedema, acute kidney injury with proteinuria and hypertension. Further investigations showed a high titre of double-stranded DNA antibodies, anti-cardiolipin IgM and B2 microglobulin positive and low C3. She also developed a haemolytic anaemia and thrombocytopenia during her admission. She received pulsed steroid therapy and was started on mycophenolate mofetil (MMF) for a probable lupus nephritis awaiting the results of biopsy, which showed later a lupus nephritis Class IV-G with active lesions. She then developed symptoms of COVID-19 infection and had a positive PCR leading to an interruption of her induction therapy. She was recruited to the RECOVERY trial on the lopinavir-ritonavir arm and made a good recovery. Case report - Discussion It is well known that viruses can trigger or aggravate auto-immune response in patients predisposed genetically. However, the role of SARS-coV-2 is not elucidated yet. The EULAR COVID-19 registry showed that rheumatoid arthritis and SLE were the most prevalent rheumatic diseases, and there was an increased risk in those who are on moderate to high dose corticosteroids. In patients with SLE and COVID-19 infection, it is agreed by all the national and international rheumatology societies to interrupt their immunosuppressive therapy until the symptoms resolve, especially those with renal involvement or an active disease. Which is the case in our patient. Luckily, she resumed her MMF a month later after a negative PCR and her renal function has continued to improve. Case report - Key learning points Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE. It requires an early immunosuppressive treatment to induce remission. Randomized clinical trials showed that MMF is at least equally effective as cyclophosphamide in inducing remission and that it has been associated with a reduced risk of infection and amenorrhea. It seems to be a suitable alternative in women of childbearing age. In patients with concomitant COVID-19 disease, immunosuppressive therapy should be paused until the symptoms improve.

scholarly journals Dialysis and Pregnancy in End Stage Kidney Disease Associated with Lupus Nephritis

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Goutham Sivasuthan ◽  
Rumbi Dahwa ◽  
George T. John ◽  
Dwarakanathan Ranganathan
Keyword(s):  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
The Other ◽  
Rare Occurrence ◽  
Automated Peritoneal Dialysis ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
End Stage Kidney Disease ◽  
Successful Pregnancy ◽  
End Stage

Female patients with systemic lupus erythematosus are often of childbearing age at diagnosis, and though fertility in these patients is similar to the general population, successful pregnancy remains a rare occurrence. This incidence is, however, increasing and the management of these high risk pregnancies is often further complicated by the patient’s need for dialysis as a result of lupus nephritis (LN). We share our experience in managing two LN patients with successful pregnancies, one on automated peritoneal dialysis and the other on haemodialysis, as well as a review of cases in the literature.

Pregnancy Outcomes in A Group Egyptian Patients with Systemic Lupus Erythematosus: A Cohort Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
DF Mohammed ◽  
HE Mansour ◽  
AE El-Feky ◽  
SM Hosny ◽  
CS Morad ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cohort Study ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Fetal Loss ◽  
University Hospital ◽  
Intrauterine Fetal Death ◽  
Control Group ◽  
Childbearing Age ◽  
Systemic Lupus

Abstract Background Systemic lupus erythematosus (SLE) predominantly affects women of childbearing age thus pregnancy in lupus patients is a common clinical scenario. SLE adversely affects pregnancy outcomes and pregnancy leads to SLE flares Aim of the work Determining the frequencies and predictors of maternal and fetal pregnancy outcomes in women with SLE by a prospective cohort study Patients and methods seventy-one pregnant lupus patients were followed prospectively, and their data compared to age-matched pregnant healthy controls attending Ain Shams University Hospital clinics Results Thirteen Patients had activity at conception. Sixty-six(93%) Where on treatment. Flares occurred in 51 patients (72%) during pregnancy with nephritis being the most common occurring in 78%. The prevalence of anemia, AKI and hypertension (HTN) during pregnancy were higher in SLE group than control group (P < 0.01). The rate of delivery by Cesarean section (CS), PTL, postpartum hemorrhage, preeclampsia (PE), severe PE and HELLP were higher in SLE group then control group (P < 0.01) as well as an increase in rate of postpartum infection (P < 0.05). There was an increase in rate of fetal loss, prematurity, intrauterine growth restriction (IUGR), NICU admission, still birth/intrauterine fetal death and highly significant decrease in fetal weight in SLE group than control group (P < 0.01). Pregestational HTN was independently associated with PE (OR 91.228; CI 6.791-1225.538). Proteinuria and HTN during pregnancy were independently associated with prematurity (OR 14.162 CI 1.029-194.958 & OR 10.596, CI 1.460-76.894). Conclusion Pregnancy in lupus patients carries a higher risk of pregnancy morbidity and worse fetal outcomes than the controls.

scholarly journals Disruption of Glucocorticoid Action on CD11c+ Dendritic Cells Favors the Generation of CD4+ Regulatory T Cells and Improves Fetal Development in Mice

2021 ◽  
Vol 12 ◽  
Author(s):  
Lianghui Diao ◽  
Alexandra Maximiliane Hierweger ◽  
Agnes Wieczorek ◽  
Petra Clara Arck ◽  
Kristin Thiele
Keyword(s):  
Dendritic Cells ◽  
Fetal Development ◽  
Immune Cell ◽  
Fetal Loss ◽  
Treg Cells ◽  
Cell Functions ◽  
Adaptive Immune Cells ◽  
Uterine Growth ◽  
Intra Uterine Growth Restriction ◽  
Functional Relevance

A wealth of innate and adaptive immune cells and hormones are involved in mounting tolerance towards the fetus, a key aspect of successful reproduction. We could recently show that the specific cross talk between the pregnancy hormone progesterone and dendritic cells (DCs) is significantly engaged in the generation of CD4+ FoxP3+ regulatory T (Treg) cells while a disruption led to placental alterations and intra-uterine growth restriction. Apart from progesterone, also glucocorticoids affect immune cell functions. However, their functional relevance in the context of pregnancy still needs clarification. We developed a mouse line with a selective knockout of the glucocorticoid receptor (GR) on DCs, utilizing the cre/flox system. Reproductive outcome and maternal immune and endocrine adaptation of Balb/c-mated C57Bl/6 GRflox/floxCD11ccre/wt (mutant) females was assessed on gestation days (gd) 13.5 and 18.5. Balb/c-mated C57Bl/6 GRwt/wtCD11ccre/wt (wt) females served as controls. The number of implantation and fetal loss rate did not differ between groups. However, we identified a significant increase in fetal weight in fetuses from mutant dams. While the frequencies of CD11c+ cells remained largely similar, a decreased expression of co-stimulatory molecules was observed on DCs of mutant females on gd 13.5, along with higher frequencies of CD4+ and CD8+ Treg cells. Histomorphological and gene expression analysis revealed an increased placental volume and an improved functional placental capacity in mice lacking the GR on CD11c+ DCs. In summary, we here demonstrate that the disrupted communication between GCs and DCs favors a tolerant immune microenvironment and improves placental function and fetal development.

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