Reynolds Monica L, Gibson Keisha L, Manuck Tracy A, Poulton Caroline J, Blazek Lauren, Stuebe Alison M, Hogan Susan L, Falk Ronald J, Derebail Vimal K
University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
University of North Carolina (UNC) Maternal and Fetal Medicine, Division of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Nephrol. 2024 Jul 30;4:1402597. doi: 10.3389/fneph.2024.1402597. eCollection 2024.
Individuals with lupus nephritis (LN) are at high risk of adverse maternal and fetal outcomes in pregnancy. Outside of pregnancy, proliferative lesions on kidney biopsies are associated with disease progression, but these have not been consistently associated with increased risk in pregnancy. This retrospective, single-center study examines how histologic findings, the timing from kidney biopsy to pregnancy, and the clinical features in the first trimester are associated with preterm birth among individuals with LN. Among 35 deliveries in 31 women, the mean gestational age at delivery was 33.8 weeks. The presence of a urine protein-to-creatinine ratio >0.5 g/g in the first trimester was associated with preterm delivery (81% vs. 36%, = 0.04). Preterm birth was more common in individuals with glomerular crescents on biopsy (89% in those with >20% crescents vs. 50% in those with <20%, = 0.06). A pregnancy occurring within 2 years after a kidney biopsy was more likely to result in preterm birth than if the biopsy was performed more than 2 years prior to conception (82% vs. 23%, = 0.01). The time from diagnostic biopsy may be a surrogate for disease activity, and a 2-year delay from biopsy might allow sufficient time to achieve disease remission. Overall, these data could aid family planning discussions and promote preconception disease optimization for patients and their providers.
狼疮性肾炎（LN）患者在妊娠期间出现不良母婴结局的风险很高。在非妊娠状态下，肾活检的增殖性病变与疾病进展相关，但这些病变与妊娠风险增加之间并未始终存在关联。这项回顾性单中心研究探讨了组织学检查结果、从肾活检到妊娠的时间以及孕早期的临床特征与LN患者早产之间的关系。在31名女性的35次分娩中，平均分娩孕周为33.8周。孕早期尿蛋白与肌酐比值>0.5 g/g与早产相关（81%对36%，P = 0.04）。肾活检有肾小球新月体的患者早产更为常见（新月体>20%的患者中为89%，<20%的患者中为50%，P = 0.06）。肾活检后2年内妊娠比在受孕前2年以上进行活检更易导致早产（82%对23%，P = 0.01）。诊断性活检后的时间可能是疾病活动的一个替代指标，活检后延迟2年可能有足够时间实现疾病缓解。总体而言，这些数据有助于进行计划生育讨论，并促进患者及其医疗服务提供者在孕前优化疾病状况。
