Recommendations for a woman anticipating pregnancy with a history of SLE nephritis

Recommendations for a woman anticipating pregnancy with a history of SLE nephritis

  • • Stop renin–angiotensin blockade medications prior to conception:
  • • Patients should be in remission for at least 6 months.
  • • Follow proteinuria off angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker prior to pregnancy; expect baseline proteinuria to increase with increased glomerular filtration rate during pregnancy.
  • • Hydroxychloroquine may help prevent intrauterine growth restriction.
  • • Anti-dsDNA levels are not affected by pregnancy and can be followed as a sign of disease flare in some individuals with increasing proteinuria.
  • • The risk of renal biopsy is likely not increased for patients in the first and second trimester (if aPLA-negative and not on anticoagulation), but best done prior to pregnancy if there is a concern for active nephritis.

Pearl: complements are elevated during pregnancy, so even normal levels that are dropping may indicate an SLE flare.

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