Complete remission in Lupus nephritis among women tied to good pregnancy outcomes

China: In a new study conducted by Yinghua Chen and the team, it was shown that patients with lupus nephritis (LN) who had been in complete renal remission (CRR) for more than 18 months had better pregnancy outcomes and decreased LN recurrence. The findings of this study were published in the journal Nephrology Dialysis Transplantation.

Pregnancy in lupus nephritis patients remains difficult for both patients and professionals. The identification of pregnancy outcome predictors is important for minimizing maternal and fetal risks, which have been intensively studied in LN patients; however, few studies have focused on LN patients with full renal remission. As a result, in order to better understand pregnancy outcomes and establish more suitable pregnancy plans in LN, this study retrospectively assessed the pregnancy outcomes of 158 pregnancies in 155 patients with LN, as well as the risk factors for bad pregnancy outcomes in LN with CRR.

The key findings of this study were as follows:

1. 130 LN patients with 133 pregnancies (two twin pregnancies) in the remission group, gave 127 live newborns; in the control group, 25 LN patients with 25 pregnancies delivered 19 live births.

2. The remission group had a considerably decreased rate of LN recurrence, fetal loss, and early delivery when compared to the control group.

3. A CRR duration of 18 months and anti-C1q antibody positivity before pregnancy were independent risk factors for LN relapse in the remission group; antiphospholipid antibody positivity and prednisone dosage during pregnancy of 12.5 mg/day were independent risk factors for fetal loss and premature birth, respectively; and age >30 years was an independent predictor for preeclampsia and premature birth.

In conclusion, this study found that LN patients who had CRR for more than 18 months had better pregnancy outcomes and less LN recurrence during pregnancy. In LN patients, age >30 years, anti-C1q, aPL positive, and a Pred dose of 12.5 mg/day during pregnancy were risk factors for unfavorable maternal and fetal outcomes.

Reference:

Chen, Y., Li, K., Zhang, H., Liu, Z., Chen, D., Yang, L., & Hu, W. (2021). Good pregnancy outcomes in lupus nephritis patients with complete renal remission. In Nephrology Dialysis Transplantation. Oxford University Press (OUP). https://doi.org/10.1093/ndt/gfab289