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Successful management of systemic lupus erythematosus nephritis flare-up during pregnancy with tacrolimus

  • Case Report
  • Published:
Modern Rheumatology

Abstract

Systemic lupus erythematosus (SLE) is one of the common autoimmune disorders that affect women during their childbearing years. Disease activity frequently increases during pregnancy and the postpartum period, representing a challenge for both the patient and the treating physician(s). We report a case of successful management of lupus nephritis flare in the first trimester. The patient developed bilateral leg edema and nephrotic-range proteinuria of 5 g/day. She was treated with steroids and tacrolimus, which resulted in the induction of remission during pregnancy. The patient reached full-term with no maternal or fetal complications. This case indicates that tacrolimus, which is convenient to use and has limited adverse effects, may represent a potential safe and effective treatment option for SLE nephritis during pregnancy.

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References

  1. Petri M, Howard D, Repke J. Frequency of lupus flare in pregnancy: the Hopkins lupus pregnancy center experience. Arthritis Rheum. 1991;34:1538–45.

    Article  CAS  PubMed  Google Scholar 

  2. Ruiz-Irastorza G, Lima F, Alves J, Khamashta MA, Simpson J, Hughes GR, Buchanan NM. Increased rate of lupus flare during pregnancy and the puerperium; a prospective study of 78 pregnancies. Br J Rheumatol. 1996;35:133–8.

    Article  CAS  PubMed  Google Scholar 

  3. Gourly MF, Austin HA 3rd, Scott D, Yarboro CH, Vaughan EM, Muir J, Boumpas DT, Klippel JH, Balow JE, Steinberg AD. Methylprednisolone and cyclophosphamide, alone or in combination, in patients with lupus nephritis A randomized, controlled trial. Ann Intern Med. 1996;125:549–57.

    Google Scholar 

  4. Clowse ME, Magder L, Petri M. Cyclophosphamide for lupus during pregnancy. Lupus. 2005;14:593–7.

    Article  CAS  PubMed  Google Scholar 

  5. Contreras G, Pardo V, Leclercq B, Lenz O, Tozman E, O’Nan P, Roth D. Sequential therapies for proliferative lupus nephritis. N Engl J Med. 2004;350:971–80.

    Article  CAS  PubMed  Google Scholar 

  6. Steinberg AD, Steinberg SC. Long-term preservation of renal function in patients with lupus nephritis receiving treatment that includes cyclophosphamide versus those treated with prednisone only. Arthritis Rheum. 1991;34:945–50.

    Article  CAS  PubMed  Google Scholar 

  7. Ostensen M, Khamashta M, Lockshin M, et al. Anti-inflammatory, immunosuppressive drugs, reproduction. Arthritis Res Ther. 2006;8:209.

    Article  PubMed  Google Scholar 

  8. Bar Oz B, Hackman R, Einarson T, Koren G. Pregnancy outcome after cyclosporine therapy during pregnancy: a meta-analysis. Transplantation. 2001;71:1051–5.

    Article  CAS  PubMed  Google Scholar 

  9. Szeto C, Kwan BC-H, Lai FM-M, Tam L-S, Li EK-M, Chow K-M, Gang W, Li PK-T. Tacrolimus for the treatment of systemic lupus erythematosus with pure class V nephritis. Rheumatology. 2008;47:1678–81.

    Article  CAS  PubMed  Google Scholar 

  10. Pergola PE, Kancharla A, Riley DJ. Kidney transplantation during the first trimester of pregnancy: immunosuppression with mycophenolate mofetil, tacrolimus, and prednisone. Transplantation. 2000;71:994–7.

    Article  Google Scholar 

  11. Armenti VT, Constantinescu S, Moritz MJ, et al. Pregnancy after transplantation. Transplant Rev (Orlando). 2008;22:223–40.

    Google Scholar 

  12. Khan SS, Constantinescu S, Silva P, et al. Pregnancy outcomes in renal transplant recipients on Neoral vs. tacrolimus. J Am Soc Nephrol. 2006;17:562A.

    Google Scholar 

  13. Kainz A, Harabacz I, Cowlrick IS, Gadgil SD, Hagiwara D. Review of the course and outcome of 100 pregnancies in 84 women treated with tacrolimus. Transplantation. 2000;70:1718–21.

    Article  CAS  PubMed  Google Scholar 

  14. Armenti VT, Moritz MJ, Davison JM. Drug safety issues in pregnancy following transplantation and immunosuppression: effects and outcomes. Drug Saf. 1998;19:219–32.

    Article  CAS  PubMed  Google Scholar 

  15. McKay D, Josephson M. Reproduction and transplantation: report on the AST consensus conference on reproductive issues and transplantation. Am J Transplant. 2005;5:1–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11321, Saudi Arabia

    Abdulkareem Alsuwaida

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  1. Abdulkareem Alsuwaida
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Correspondence to Abdulkareem Alsuwaida.

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Alsuwaida, A. Successful management of systemic lupus erythematosus nephritis flare-up during pregnancy with tacrolimus. Mod Rheumatol 21, 73–75 (2011). https://doi.org/10.1007/s10165-010-0340-4

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  • DOI: https://doi.org/10.1007/s10165-010-0340-4

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