Can women with lupus nephritis have a safe pregnancy?

Question

Hello doctor,

My 28-year-old daughter was diagnosed with lupus nephritis two years ago, and ever since then, she has been in and out of the hospital. Her kidney function keeps getting worse despite being on Prednisone 60 mg daily and Mycophenolate. Her latest labs show creatinine at 2.8, and protein in urine is 4+, which the nephrologist says indicates her lupus nephritis is progressing. She also has horrible joint pain in her hands, knees, and ankles that makes it hard for her to work as a teacher. The swelling in her legs and face is so bad that she does not even look like herself anymore.

Her blood pressure is up to 155/98 mg/dl, even on Lisinopril and Amlodipine. The worst part is that she just got married last year and wants to start a family, but doctors told her it is too dangerous with active lupus nephritis. She gets these terrible rashes on her face, especially across her cheeks, that look like a butterfly shape. Her ANA is positive at 1:640, and complement levels C3 and C4 are really low. She tried Hydroxychloroquine, but it gave her terrible stomach problems.

Is there any chance her kidney function can improve, or will she need dialysis eventually?
Can women with lupus nephritis ever have safe pregnancies?

She is so depressed about not being able to have children.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com

I read your query and understand your concern.

Lupus nephritis is an autoimmune condition affecting the kidneys and causing them to swell.

That affects the function of the kidneys, leading to improper waste management in the body, high blood pressure, and, eventually, kidney failure. This is an autoimmune condition; there is no cure because it is all mediated through the immune system. It can cause swelling of the face, hands, and feet and raise creatinine levels in the blood. Women are more likely to be affected by lupus. If the disease keeps progressing and there is kidney failure, your daughter may require dialysis as well, but with dietary and lifestyle modifications, one can control disease progression to some level.

Drugs like corticosteroids and immunosuppressants do help with the inflammation. You have to limit salt and protein in your diet strictly, and I hope you already know that. Pregnancy with lupus nephritis is possible, but that is going to be a high-risk pregnancy, leading to several maternal and fetal complications. So, complete planning and a team of doctors would be required for constant monitoring. But with active lupus, I will not suggest going ahead with planning for pregnancy. Let the disease come to a stable stage, and then you may discuss the same.

Autoimmune disease largely requires lifestyle changes, like stress management, plenty of nutrition-rich foods, and a proper sleep schedule.

I hope this helps.

Thank you.