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Patients with lupus without history of kidney disease rarely got kidney disease during pregnancy
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In a recently published observational study, patients with lupus who did not have a history of kidney disease rarely got kidney disease during pregnancy.
“During pregnancy, the kidneys work harder and if the kidneys filter more, [then] maybe that kind of stress and strain in someone who might have a predisposition who has lupus kidney disease is going to be a bad thing,” Jill P. Buyon, MD, at New York University/Langone Medical Center, told Healio Rheumatology. “So, that is a big question out there that patients ask their physicians and physicians ask each other: Is getting pregnant a risk for developing brand new kidney disease with lupus when you have never had it before? [One] thing the study said was if you never had kidney disease before, your chances of having it happen just because you were pregnant were low. It was 2%.”
Between 2003 and 2012, Buyon and colleagues assessed 373 pregnant women with lupus. Overall, 48% were white. They found 4.6% of patients had renal flares or de novo kidney disease, which occurred in 7.9% of those with prior kidney disease in complete remission and in 20.7% of those with prior disease in partial remission. In women without a history of kidney disease, new onset of kidney disease occurred in fewer than 2% of pregnancies and was not linked with any adverse pregnancy outcome. In addition, age, blood pressure, creatinine and current use of hypertensive medication were not linked with any kidney outcome. Also, current use of glucocorticoids, hydroxychloroquine, azathioprine, aspirin or heparin, as well as past treatment with methotrexate or cyclophosphamide, were not linked with de novo kidney disease or renal flares.
“So [these results], while not earth shattering on face value, can be reassuring to us as clinicians and [to patients],” Buyon said. “I think this information is a good thing. It is reinforcing what we hoped we would find.”
However, Buyon and colleagues also found patients with a history of kidney disease more often had an increase in proteinuria compared to those without a history of kidney disease (11% vs. 1.6%), which was a significant association. In addition, low C4 at baseline was linked with renal flares and de novo kidney disease, but low C3 or positive double stranded DNA positivity were not.
“For people who were not in complete remission — so they were still spilling a little bit of protein — that was the more vulnerable group to developing more protein during pregnancy,” Buyon said. “So, that message is you would like a patient to not be spilling protein during pregnancy, that would be best for them. But even those who did spill protein, four out of five of them did well without any worsening of their protein in the urine. And overall, most of these people did well generally, and that is the message.” – by Will A. Offit
Disclosures: The researchers report no relevant financial disclosures.
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Elizabeth Kirchner, MSN, CNP
This research is important in helping solve one piece of the lupus puzzle. Clinicians and patients can rest easier, knowing that SLE patients with no manifestations of renal involvement can be reasonably certain that pregnancy will not precipitate targeting of the kidneys by their disease. However, studies like this one also serve as a reminder of how heterogeneous SLE is and how far we have to go in terms of disease management, predicting outcomes and treatment.
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