Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood

Authors

  • Kaliki Hymavathi Reddy Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Kolla Praveen Kumar Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Surekha Tadisetti Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
  • Divya Pusarla Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20164689

Keywords:

Grade IV lupus nephritis, Recurrent pregnancy failure, Secondary antiphospholipid antibody syndrome

Abstract

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section.

References

David A. Warrell, Timothy M. Cox, John D. Firth. Oxford textbook of Medicine 5th Edition. 2010;267(1).

Kasper, Braunwald, Fauci, hauser, longo, jameson. Harrison’s Principles of Internal Medicine 16th edition. 1960.

Weening JJ, D’Agati VD, Schwartz MM. J Am Soc Nephrol. 2004;15:835-6.

Contreras G, Roth D, Pardo V, Striker LG, Schultz DR. Lupus nephritis: A clinical review for practicing nephrologists. Clin Nephrol. 2002;57:95-107.

Contreras G, Pardo V, Cely C, Borja E. Factors associated with poor outcomes in patients with lupus nephritis. 2005;14:890-5.

Practice Bulletin No ACOG; American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Obstetrics: Antiphospholipid syndrome. Obstet Gynecol. 2011;117:192-9.

Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus erythematosus. Results of a multidisciplinary approach. J Rheumatol. 1986;13:732-9.

Rahman P, Gladman DD, Urowitz MB. Clinical predictors of fetal outcome in systemic lupus erythematosus. J Rheumatol. 1998;25:1526-30.

Martinez-Rueda JO, Arce-Saluas CA, Kraus A et al. Factors associated with fetal losses in severe SLE. Lupus. 1996;5:113-9.

Moroni G, Ponticelli C. Pregnancy after lupus nephritis. Lupus. 2005;14:89-94.

Levy RA, Avaad E, Oliviera J. Placental pathology in antiphospholipid syndrome. 1998;7:S81-5.

Magid MS, Kaplan S, Sammaritano LR. Placental pathology in SLE: a prospective study. Am J Obstet Gynecol. 1998;79:226-34.

Iozza I, Cianci S. Update on systemic lupus erythematosus pregnancy. J Prenat Med. 2010;4(4):67-73.

Clara J. Day1, Graham W. Lipkin1 and Caroline O. S. Savage. Lupus nephritis and pregnancy in the 21st century. Nephrol. Dial. Transplant. 2009;24(2):344-7.

Mackillop LH, Germain SJ, Nelson-Piercy C. Systemic lupus erythematosus. Br Med J. 2007;335:933-6.

Germain S, Nelson-Piercy C. Lupus nephritis and renal disease in pregnancy. Lupus. 2006;15:148-55.

Ioannou Y, Zhang JY, Qi M. Novel assays of thrombogenic pathogenicity for the antiphospholipid syndrome based on the detection of molecular oxidative modification of the major autoantigen β2-glycoprotein I. Arthritis Rheum. 2011;63:2774-82.

Knight M, Duley L, Handerson Smart DI. Antiplatelet agents for preventing pre-eclampsia (Cochrane Review). The Renal Health Library. 2005.

Day C, Hewins P, Hildebrand S, Sheikh L, Taylor G, Kilby M. The role of renal biopsy in women with kidney disease identified in pregnancy.Nephrol Dial Transplant. 2008;23:201-6.

Askanase AD, Friedman DM. Spectrum and progression of conduction abnormalities in infants born to mothers with anti-SSA/Ro-SSB/La antibodies. 2002;11:145-51.

Downloads

Published

2016-12-20

Issue

Section

Case Reports