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World J Nephrol. Dec 25, 2024; 13(4): 99700
Published online Dec 25, 2024. doi: 10.5527/wjn.v13.i4.99700
Relationship of lupus nephritis and pregnancy: A narrative review
Tabassum Elahi, Saima Ahmed, Muhammed Mubarak
Tabassum Elahi, Saima Ahmed, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Author contributions: Elahi T, Ahmed S, and Mubarak M contributed equally to the conception and study design. They performed relevant research, participated in primary and final drafting, and read and approved the final manuscript.
Conflict-of-interest statement: No conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammed Mubarak, FCPS, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Received: July 28, 2024
Revised: October 22, 2024
Accepted: October 29, 2024
Published online: December 25, 2024
Processing time: 101 Days and 21.8 Hours
Abstract

Pregnancy in women with lupus, particularly those with lupus nephritis (LN), carries an increased risk of adverse outcomes. Women with active LN at the time of conception are at a high risk of poor maternal and fetal outcomes. Recent studies indicate that even in the presence of quiescent disease, factors such as hypertension and positive lupus anticoagulant are predictors of worse pregnancy outcomes. Consequently, pre-conception evaluation is essential to ensure that pursuing pregnancy is safe and timely, and to facilitate proper planning for optimizing medical regimens, discontinuing teratogenic agents, and treating active disease. Additionally, pre-existing LN is associated with higher rates of preeclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Women with lupus and prior LN can have successful pregnancies, but a multidisciplinary approach with close monitoring is essential for optimal outcomes. By systematically reviewing the available evidence, this narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy, offering insights to guide clinical practice and future research in this field.

Keywords: Lupus nephritis; Pregnancy; Systemic lupus erythematosus; Fetal development; Maternal complications

Core Tip: Pregnancy in women with lupus, particularly lupus nephritis (LN), carries an increased risk of adverse outcomes. Women with active LN at conception are at a high risk of poor maternal and fetal outcomes. Pre-conception evaluation is essential to ensure proper planning for optimizing medical regimens, discontinuing teratogenic agents, and treating active disease. Women with prior LN can have successful pregnancies, but a multidisciplinary approach with close monitoring is essential. This narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy, offering insights to guide clinical practice and future research in this field.