Challenges associated with active lupus nephritis in pregnancy and distinguishing between lupus nephritis and preeclampsia: Case report of a high-pressure situation
Main Article Content
Abstract
Active lupus nephritis poses severe maternal and fetal risks in pregnant patients. Management in pregnancy is challenging and limited by lack of pregnancy-safe medication options. Preeclampsia is an associated maternal risk that shares many clinical features with lupus nephritis, often making it difficult to identify the primary disease process. In this report, we present a case of severe preeclampsia superimposed on active lupus nephritis in a 25-year-old pregnant female. We highlight the risks and management options for lupus nephritis in pregnancy, the overlaps in presentation between lupus nephritis and preeclampsia, and techniques to clinically distinguish between the two.
Keywords:
lupus nephritis, lupus nephritis in pregnancy, distinguishing between lupus nephritis and preeclampsia, Challenges associated with active lupus nephritis
Article Details
How to Cite
SAKLECHA, Anokhi; SMITH, Chelsey J. F..
Challenges associated with active lupus nephritis in pregnancy and distinguishing between lupus nephritis and preeclampsia: Case report of a high-pressure situation.
Medical Research Archives, [S.l.], v. 11, n. 1, jan. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3446>. Date accessed: 20 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i1.3446.
Section
Case Reports
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Musa R, Brent LH, Qurie A. Lupus Nephritis. StatPearls. Published January 2020. https://www.ncbi.nlm.nih.gov/books/NBK499817/
3. Stanhope TJ, White WM, Moder KG, Smyth A, Garovic VD. Obstetric Nephrology: Lupus and Lupus Nephritis in Pregnancy. Clinical Journal of the American Society of Nephrology. 2012;7(12):2089-2099. doi:10.2215/CJN.12441211
4. Wagner LK. Diagnosis and Management of Preeclampsia. American Family Physician. 2004;70(12):2317-2324. https://www.aafp.org/pubs/afp/issues/2004/1215/p2317.html
5. Pankiewicz K, Szczerba E, Maciejewski T, Fijałkowska A. Non-obstetric complications in preeclampsia. Menopausal Review. 2019;18(2). doi:10.5114/pm.2019.85785
6. Varnier N, Brown MA, Reynolds M, et al. Indications for delivery in pre-eclampsia. Pregnancy Hypertension. 2018;11:12-17. doi:10.1016/j.preghy.2017.11.004
7. Saxena R, Mahajan T, Mohan C. Lupus nephritis: current update. Arthritis Research & Therapy. 2011;13(5):240. doi:10.1186/ar3378
8. Gasparotto M, Gatto M, Binda V, Doria A, Moroni G. Lupus nephritis: clinical presentations and outcomes in the 21st century. Rheumatology (Oxford, England). 2020;59(Suppl 5):v39-v51. doi:10.1093/rheumatology/keaa381
9. Tektonidou MG, Dasgupta A, Ward MM. Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971-2015: A Systematic Review and Bayesian Meta-Analysis. Arthritis & Rheumatology. 2016;68(6):1432-1441. doi:10.1002/art.39594
10. Lightstone L, Hladunewich MA. Lupus Nephritis and Pregnancy: Concerns and Management. Seminars in Nephrology. 2017;37(4):347-353. doi:10.1016/j.semnephrol.2017.05.006
11. Bremme K, Honkanen S, Gunnarsson I, Chaireti R. The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus. Lupus. 2021;30(7):1031-1038. doi:10.1177/09612033211004716
12. Chakravarty EF, Colón I, Langen ES, et al. Factors that predict prematurity and preeclampsia in pregnancies that are complicated by systemic lupus erythematosus. American Journal of Obstetrics and Gynecology. 2005;192(6):1897-1904. doi:10.1016/j.ajog.2005.02.063
13. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Care & Research. 2020;72(4):461-488. doi:10.1002/acr.24130
14. Davidson KW, Barry MJ, Mangione CM, et al. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality. JAMA. 2021;326(12):1186. doi:10.1001/jama.2021.14781
15. Buyon JP, Cronstein BN, Morris M, Tanner M, Weissmann G. Serum complement values (C3 and C4) to differentiate between systemic lupus activity and pre-eclampsia. The American Journal of Medicine. 1986;81(2):194-200. doi:10.1016/0002-9343(86)90251-2
16. Tanaka M, Tsujimoto Y, Goto K, et al. Preeclampsia before 20 weeks of gestation: a case report and review of the literature. CEN Case Reports. 2014;4(1):55-60. doi:10.1007/s13730-014-0140-3
17. Bainbridge SA, Roberts JM. Uric Acid as a Pathogenic Factor in Preeclampsia. Placenta. 2008;29:67-72. doi:10.1016/j.placenta.2007.11.001
18. Falasinnu T, Simard JF. 283 Supporting evidence to differentiate preeclampsia from nephritis in lupus pregnancy: an electronic health records review. Lupus Science & Medicine. 2019;6(Suppl 1). doi:10.1136/lupus-2019-lsm.283