Maternal and fetal outcomes in pregnant patients with lupus nephritis

Authors

  • Duminda B. Basnayake Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka. Centre for Research, National Hospital Kandy, Sri Lanka
  • Abdul W. M. Wazil Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka
  • Nishantha Nanayakkara Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka. Centre for Research, National Hospital Kandy, Sri Lanka
  • Ayesha Nayanamali Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka.Centre for Research, National Hospital Kandy, Sri Lanka
  • Ruwina A. Deepani Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka
  • Inoka Chathurani Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka
  • Kushan T. Thennakoon Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka
  • Naduni H. Erandika Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka. Centre for Research, National Hospital Kandy, Sri Lanka
  • Buddhika Wijayawickrama Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka. Centre for Research, National Hospital Kandy, Sri Lanka
  • Dulani K. Devagiri Department of Nephrology and Renal Transplant, National Hospital Kandy, Sri Lanka

DOI:

https://doi.org/10.18203/2320-6012.ijrms20210863

Keywords:

Lupus nephritis, Pregnancy, Maternal outcomes, Fetal outcomes, Sri Lanka

Abstract

Background: Pregnancy in a woman with lupus nephritis (LN) carries a high risk of maternal and fetal morbidity and mortality. This study aims to analyze the effect of LN on maternal and fetal outcomes and lupus activity.

Methods: In a single-center, cross-sectional observational study at national hospital Kandy, 32 pregnancies in 23 women with biopsy-proven LN between 2007 and 2019 were analyzed retrospectively.

Results: Mean age at pregnancy was 28.4 years (SD=4.8, range 19–38 years). In six women, LN developed during pregnancy, 17 patients were already diagnosed with LN when they became pregnant. A renal biopsy performed 4.6 (SD=3.8) years before pregnancy, showed diffuse LN in 18 (78.3%) and focal LN in 5 (21.7%) cases. At conception, most patients were in complete (43.8%) or partial (21.9%) remission. Therapeutic abortion was performed in 8 pregnancies (indications: renal flares in 5, pre-eclampsia in 3) at a mean period of amenorrhea (POA) of 16.8 weeks (range 8-28 weeks). Spontaneous fetal loss occurred in one pregnancy. Among 23 live births, there were four pre-term deliveries (<36 weeks gestation) and 19 term deliveries. In term deliveries mean birth weight was 2.62 kg (SD=0.5) and in pre-term babies, it was 1.85 kg. Sixteen caesarian sections were performed in term deliveries, three as emergencies. All the pre-term babies were delivered by emergency caesarian sections. There was no statistically significant relationship (p>0.05) between LN histological type, initial clinical presentation and treated hypertension with fetal outcome. No case of neonatal lupus or congenital heart block was noted. During pregnancy, there were five (15.6%) renal flares and two acute kidney injury cases; all were reversible. Eight patients (25%) developed PIH

Conclusions: Pregnancy induced hypertension is a more commonly encountered complication in pregnancies with lupus nephritis. The fetal outcome is unfavorable in pregnancies with renal flares.

 

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Published

2021-02-25

How to Cite

Basnayake, D. B., Wazil, A. W. M., Nanayakkara, N., Nayanamali, A., Deepani, R. A., Chathurani, I., Thennakoon, K. T., Erandika, N. H., Wijayawickrama, B., & Devagiri, D. K. (2021). Maternal and fetal outcomes in pregnant patients with lupus nephritis. International Journal of Research in Medical Sciences, 9(3), 670–675. https://doi.org/10.18203/2320-6012.ijrms20210863

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Original Research Articles