Moroni Gabriella, Calatroni Marta, Ponticelli Claudio
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy.
Expert Rev Clin Immunol. 2022 May 10:1-13. doi: 10.1080/1744666X.2022.2074399.
Women with systemic lupus erythematosus (SLE), particularly those with lupus nephritis (LN), remain at high risk for adverse pregnancy outcome. Although in the last decades maternal and fetal outcomes have improved dramatically, preeclampsia remains a major cause of maternal and perinatal morbidity and mortality.
A narrative review of literature was conducted, underlying the importance of pre-conception counseling, and focusing on the correlation between preeclampsia and LN. The clinical characteristics of preeclampsia were described, with emphasis on risk factors in LN and the differential diagnosis between preeclampsia and lupus flares. Additionally, the prevention and treatment of preeclampsia were discussed, as well as the management of short-term and long-term consequences of preeclampsia. We highlight the importance of a pre-pregnancy counseling from a multidisciplinary team to plan pregnancy during inactive SLE and LN.
Further studies are needed to evaluate the long-term consequences of pregnancy in LN. Considering that preeclamptic patients can be at high risk for long-term renal failure, we suggest renal checkup for at least 6-12 months after delivery in all patients.
系统性红斑狼疮（SLE）女性，尤其是狼疮性肾炎（LN）患者，妊娠不良结局风险仍然很高。尽管在过去几十年中母婴结局有了显著改善，但子痫前期仍是孕产妇和围产儿发病及死亡的主要原因。
进行了文献综述，强调了孕前咨询的重要性，并聚焦于子痫前期与LN之间的相关性。描述了子痫前期的临床特征，重点关注LN中的危险因素以及子痫前期与狼疮病情活动的鉴别诊断。此外，还讨论了子痫前期的预防和治疗，以及子痫前期短期和长期后果的管理。我们强调多学科团队进行孕前咨询对于在SLE和LN病情缓解期计划妊娠的重要性。
需要进一步研究来评估LN患者妊娠的长期后果。鉴于子痫前期患者长期肾衰竭风险较高，我们建议所有患者在产后至少进行6 - 12个月的肾脏检查。
