Q: 32 year old female at 28 weeks pregnancy is admitted to ICU with acute renal failure. Patient has known history of Systemic lupus erythematosus (SLE). Flare of lupus nephritis and preeclampsia may behave same and hard to differentiate in pregnant patients with SLE. What three points may help to differentiate between them?
Answer:
1. Preeclampsia usually only have proteinuria on urine analysis, but lupus nephritis may have proteinuria as well as red, white and cellular casts.
2. During flares of lupus nephritis theremay be probably low complement levels and increased anti-dsDNA antibodies. Preeclampsia have normal or even increased complement levels.
3. Preeclampsia is more prone to have thrombocytopenia, elevated liver enzymes (LFT) and higher uric acid level.
Abovesaid, patient should be treated in conjunction with close consult of rheumatology, nephrology and obstetrics services.
#Nephrology
#Rheumatology
#OB-Gyn
References:
1. Buyon JP, Tamerius J, Ordorica S, et al. Activation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy. Arthritis Rheum 1992; 35:55.
2. Clowse ME, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. J Rheumatol 2011; 38:1012.
Answer:
1. Preeclampsia usually only have proteinuria on urine analysis, but lupus nephritis may have proteinuria as well as red, white and cellular casts.
2. During flares of lupus nephritis theremay be probably low complement levels and increased anti-dsDNA antibodies. Preeclampsia have normal or even increased complement levels.
3. Preeclampsia is more prone to have thrombocytopenia, elevated liver enzymes (LFT) and higher uric acid level.
Abovesaid, patient should be treated in conjunction with close consult of rheumatology, nephrology and obstetrics services.
#Nephrology
#Rheumatology
#OB-Gyn
References:
1. Buyon JP, Tamerius J, Ordorica S, et al. Activation of the alternative complement pathway accompanies disease flares in systemic lupus erythematosus during pregnancy. Arthritis Rheum 1992; 35:55.
2. Clowse ME, Magder LS, Petri M. The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus. J Rheumatol 2011; 38:1012.
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