Pregnancy and lupus nephritis

Family planning and pregnancy are important and usually problematic issues for a young woman with lupus nephritis. Moderate renal insufficiency and pr evious use of alkylating cytotoxic drugs are associated with decreased fert ility. Oral contraceptives containing synthetic estrogens are contraindicat ed in women with active lupus nephritis, uncontrolled hypertension, history of thromboembolic diseases or high levels of antiphospholipid antibodies. Mild flares of systemic lupus erythematosus (SLE) are common during pregnan cy, severe renal flares and permanent impairment of renal function are unco mmon. The outlook of pregnancy for women with lupus nephritis is usually fa vourable if the disease (both renal and nonrenal) has been quiescent for at least 6 months before pregnancy, and if, at conception, serum creatinine i s less than 140 mu mol/l, proteinuria less than 3 g/24 h and blood pressure controlled. The risk of fetal loss is, however, at least 2-3 times higher than in the normal population and pre-eclampsia, prematurity and fetal grow th retardation frequently complicate these pregnancies. Especially poor fet al outcome is associated with antiphospholipid antibodies. Pregnancies in w omen with lupus nephritis require intense fetal and maternal surveillance.