Two pregnancies - two different outcomes in a patient with lupus nephritis: how to prevent obstetric and kidney complications

The systemic lupus erythematosus (SLE) negatively affects women's reproductive health. Treatment of SLE can cause premature ovarian failure, and lupus pregnancy is associated with an increased incidence of obstetric complications. Active lupus nephritis has an independent negative effect on gestational outcomes. Differential diagnosis of lupus nephritis relapses during pregnancy and preeclampsia can be difficult due to the similarity of symptoms. We present a clinical case of two pregnancies with different outcomes in a patient with lupus nephritis. During the first pregnancy, late diagnosis of SLE, gestational exacerbation of lupus nephritis, absence of immunosuppressive therapy caused nephrotic syndrome and arterial hypertension in the mother, early delivery at 32 weeks of gestation, the birth of a child with neurological complications and respiratory disorders that led to his sudden death at 7 months. Treatment with corticosteroids and pulses of cyclophosphamide caused remission of lupus nephritis but was complicated by amenorrhea. Therapy with estrogen-containing drugs has led to the restoration of fertility and did not cause a relapse of SLE. The second pregnancy occurred after preconception planning. During gestation, the patient received immunosuppressive therapy, low molecular weight heparin, and a small dose of acetylsalicylic acid. Complete remission of lupus nephritis was maintained throughout the pregnancy. Throughout pregnancy, complete remission of lupus nephritis persisted. Planned cesarean section was performed at 38 weeks of gestation, a healthy boy with a weight of 3330 g, height 51 cm was born, Apgar scores 8/9. Two months after childbirth mother demonstrated a mild relapse of lupus nephritis, which required an increased immunosuppressive therapy. The article is illustrated with photomicrographs and a comparative description of the morphological study of placental tissue. The features of the first placenta were dyssynchrony of villous tree (areas of premature maturation of the villi) and pronounced vascular changes - obliterative angiopathy of stem villi, small number of capillaries in terminal villi. These changes were probably related to SLE activity. The second placenta had well-vascularized terminal villi with wide capillaries, areas of compensatory angiomatosis. Thus, an important condition for a favorable pregnancy outcome with lupus nephritis is persistent remission of the underlying disease.

беременность, системная красная волчанка, люпус-нефрит, иммуносупрессивная терапия, исходы беременности, плацента, pregnancy, systemic lupus erythematosus, lupus nephritis, immunosuppressive therapy, pregnancy outcomes, placenta

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