Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy; Nephrology Unit, University Hospital, Parma, Via Gramsci 14, 43126, Parma, Italy.
Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Via Ferrata, 27100, Pavia, Italy.
J Autoimmun. 2017 Nov;84:46-54. doi: 10.1016/j.jaut.2017.06.003. Epub 2017 Jun 21.
No data are available about the impact of pregnancy on the long-term outcome of lupus nephritis. Thirty-two women with lupus nephritis with a 10-year follow-up after their first pregnancy ("women who gave birth") and 64 matched controls with the same follow-up and who never had pregnancies ("controls") were compared for the occurrence of SLE flares, chronic kidney disease (CKD), and SLICC/ACR Damage Index (SDI) in the post pregnancy period. The same evaluations were done before and after pregnancy in women who gave birth. The predictors of CKD and damage accrual in the whole population were studied. All patients were Caucasians and had biopsy proven LN. At conception and after 10 years, in both groups, less than 10% of patients had active renal disease (p = ns). Controls had more frequent arterial hypertension (p = 0.025). Between the two groups there was no difference in SLE flares and in CKD free survival curves (p = 0.6 and p = 0.37) during the 10-year follow-up. In both groups, the temporal trend, based on annual evaluation, of glomerular filtration rate and serum creatinine shows a significant decrease and increase respectively. However, the women who gave birth persistently maintained better values of renal function than controls during the whole follow-up (P = 0.00001). There was no difference in the CKD-free survival curves. SDI did not increase significantly in women who gave birth in comparison to controls. All the above mentioned clinical parameters were comparable before and after pregnancy in the women who gave birth. Among the basal clinical characteristics, high serum creatinine and occurrence of SLE flares predicted CKD, whereas low levels of C3, pre-existing damage score, and occurrence of SLE flares predicted SDI increase. Pregnancy was not a predictor of CKD or SDI increase. Carrying a pregnancy during inactive lupus nephritis does not seem to increase the rate of SLE flares, worsen renal prognosis or increase SDI significantly in the very long-term.
关于妊娠对狼疮肾炎长期结局的影响，目前尚无数据。对 32 名狼疮肾炎女性（“生育女性”）进行了 10 年随访，她们在首次妊娠后 10 年进行了妊娠，并与 64 名具有相同随访且从未怀孕的匹配对照（“对照”）进行了比较，以评估妊娠后 SLE 发作、慢性肾脏病 (CKD) 和 SLICC/ACR 损害指数 (SDI) 的发生情况。对生育的女性进行了妊娠前后的相同评估。研究了整个人群中 CKD 和损害累积的预测因素。所有患者均为白种人，且均经肾活检证实为 LN。在两组中，受孕时和 10 年后，不到 10%的患者存在活动性肾脏疾病（p=ns）。对照组中更常见动脉高血压（p=0.025）。在整个 10 年随访期间，两组之间 SLE 发作和 CKD 无病生存率曲线无差异（p=0.6 和 p=0.37）。在两组中，基于年度评估的肾小球滤过率和血清肌酐的时间趋势均分别显示出显著下降和增加。然而，在整个随访期间，生育的女性始终保持着比对照组更好的肾功能值（P=0.00001）。CKD 无病生存率曲线无差异。与对照组相比，生育的女性 SDI 无显著增加。生育的女性在妊娠前后，所有上述临床参数均相似。在基础临床特征中，高血清肌酐和 SLE 发作的发生预测了 CKD，而 C3 水平低、预先存在的损害评分和 SLE 发作的发生则预测了 SDI 增加。妊娠并不是 CKD 或 SDI 增加的预测因素。在不活动的狼疮肾炎期间妊娠似乎不会增加 SLE 发作的发生率，不会使肾脏预后恶化或在很长一段时间内不会显著增加 SDI。
