The challenges of pregnancy in the context of lupus nephropathy and kidney transplantation

Abstract

Background. The incidence of patients who become pregnant after renal transplantation for lupus nephritis (LN) is not fully documented, however, monitoring guidelines are available. Worldwide, studies on pregnancy after renal transplantation have recorded only a few cases of post-transplant pregnancy in the context of LN. Objective(s). Reproductive education and pregnancy planning are essential in women with kidney transplantation for lupus nephritis. These pregnancies require interdisciplinary monitoring. Materials and methods. We conducted a retrospective and prospective examination of a 34-year-old female patient who was admitted in September 2024 to the Nephrology Department of the Republican Clinical Hospital "Timofei Moșneaga" for primary evaluation due to the onset of headache, moderate arterial hypertension, leg edema, and proteinuria during pregnancy. Results. It was established that the patient who underwent a transplant for lupus nephritis from living donor was in her third pregnancy. The first pregnancy Results. ed in a full-term birth, and the second in a miscarriage at an early stage. The patient developed preeclampsia at 28 weeks of pregnancy, with a fourfold increase in proteinuria, which is why an emergency delivery was induced. After giving birth, the nephrotic syndrome persisted, which is why medium-dose pulse therapy with Methylprednisolone was administered. After pulse therapy, a partial response was achieved, manifested by a 71% reduction in proteinuria and preservation of renal function. Conclusion(s). Pregnancy after kidney transplantation in the context of a history of NL is possible, but it is a complex clinical situation associated with an increased risk of maternalfetal complications. It requires very careful multidisciplinary monitoring to rule out recurrence.