Pregnancy and the postpartum period are associated with an increased risk for SLE flares, particularly in patients with a history of lupus nephritis.
Other risk factors include discontinuation of hydroxychloroquine and active disease prior to conception.
| Clinical Presentation | • Edema • Malar rash • Arthritis • Hematuria | | --- | --- | | Laboratory findings | • Nephritic range proteinuria • Urinalysis with RBC & WBC casts • ↓ Complement levels • ↑ ANA titers | | Diagnosis | • Renal biopsy | | Obstetric complications | • Preterm birth • Cesarean delivery • Preeclampsia • Fetal growth restriction • Fetal demise |
In patients known to have SLE prior to conception, the appearance of proteinuria during pregnancy may represent an SLE flare complicated by nephritis, preeclampsia, or both. Distinguishing between lupus nephritis and preeclampsia can be difficult as both present with edema, hypertension, and proteinuria. However, lupus nephritis presents with the associated signs and symptoms of SLE (eg, joint pain, malar rash) and the presence of red blood cell casts on urinalysis. Lupus nephritis can be further distinguished from preeclampsia by decreased complement levels and increasing antinuclear antibody titers.