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Kidney Week

Abstract: PO2232

Lupus Nephritis Kidney Biopsy Characteristics and Preterm Birth

Session Information

Category: Women’s Health and Kidney Diseases

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Reynolds, Monica Lona, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Poulton, Caroline J., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Blazek, Lauren N., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Gibson, Keisha L., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Derebail, Vimal K., University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
Background

Lupus nephritis (LN) in pregnancy is associated with high rates of preterm birth (PTB). Hypocomplementemia, elevated creatinine, proteinuria and hypertension serve as risk factors. Outside of pregnancy, class IV LN and interstitial fibrosis at initial biopsy associate with progressive disease. We performed a retrospective chart review to assess if timing of kidney biopsy and histologic features increased PTB.

Methods

We included women with LN enrolled in the Glomerular Disease Collaborative Network registry who delivered at University of North Carolina (UNC) Hospital from 2001-2019. Delivery data came from the UNC perinatal database. Fishers exact test assessed biopsy characteristics and PTB (< 37 weeks).

Results

There were 36 deliveries in 32 women. Figure 1 describes the cohort. Among preconception biopsies (n=25), pregnancy occurring ≤ 24m after biopsy was more likely to result in PTB than if biopsy was performed > 24m prior to conception (82% vs 29% p =0.02). A UPCR > 0.5 mg/g in the first trimester was also associated with PTB (81% vs 36% p=0.04). PTB occurred in 69% with proliferative LN vs 50% without (ie primary diagnosis class II or V), p=0.44. Class IV LN was not significantly associated with PTB; neither was the presence of crescents (n=21/36), activity ≥ 6 (n=16/25), chronicity ≥ 3 (n=12/27), or more than mild interstitial sclerosis (n=6/33).

Conclusion

Biopsy occurring within 2 years of conception and first trimester proteinuria were significantly associated with PTB. While this presumes greater LN activity, no specific biopsy characteristic impacted the outcome. This data may aid in preconception counseling for optimal timing of conception. Calcineurin inhibitors were not used in the first trimester in this cohort; their antiproteinuric qualities and effect on PTB requires evaluation.