Identifying and managing lupus nephritis during pregnancy

Introduction: Systemic lupus erythematosus (SLE) is a multi-organ disease that commonly affects women of child bearing-age, and lupus nephritis (LN) represents one of the most severe manifestations. Advances in treatment and better knowledge of the disease have resulted in an increasing number of women seeking pregnancy. Awareness of the relationship of the condition with respect to pregnancy and long-term prognosis is important for all clinicians involved. Presentation of LN can range from mild asymptomatic proteinuria to rapidly progressive renal failure and may occur before, during, or after pregnancy. Areas covered: Here we detail the evolution of maternal disease, obstetrical and neonatal outcomes. We also report a practical approach to managing these pregnancies before, during and after analysing the predictors of poor obstetrical outcome or kidney worsening. Peculiar condition, as with kidney transplanted mothers, the onset of LN during pregnancy, or independent risk factors are also evaluated. Expert opinion: The improvement of LN therapies and better knowledge of the relationship has enormously enhanced the chance of uneventful pregnancies for LN women. A crucial step is to carefully plan the pregnancy with analysis of epidemiological, biological and therapeutic aspects that could interfere with the wellbeing of the mother and the child.