What are the risks of SLE with active lupus nephritis who would like to become pregnant?
We cannot use the PROMISSE study to examine the risks in a patient with LN because the study excluded patients with >1 g of proteinuria and those with a serum creatinine >1.2 mg/dL. This likely excludes many patients with a history of nephritis as well.
Prior studies indicate that active disease (including nephritis) portends a poor prognosis in SLE. A history of LN or current LN correlates with poor fetal and maternal outcomes including an odds ratio (OR) of 9.0 for renal flare during/after pregnancy, OR of 7.3 for fetal loss, and OR of 18.9 for preterm delivery. Maternal hypertension and aPLAs may increase these risks as well as the risk of preeclampsia.
