Navigating High-Risk Pregnancies: Interdisciplinary Strategies in Managing Lupus Nephritis During Pregnancy

Background: Lupus nephritis is a severe manifestation of systemic lupus erythematosus (SLE) that targets the kidneys, causing inflammation and possible renal impairment. It is categorized into stages according to the degree of kidney damage, with Stage 4 indicating substantial renal involvement. Management of lupus nephritis generally requires a regimen of immunosuppressive treatments, such as corticosteroids and drugs like mycophenolate mofetil or azathioprine, to alleviate inflammation and prevent the progression to chronic kidney diease . Pregnancy in patients with lupus nephritis poses distinct challenges. The interaction between lupus and pregnancy can complicate disease management, necessitating close monitoring and adjustments to treatment. Major concerns include the risk of flare-ups, possible worsening of renal function, and the effects of immunosuppressive medications on fetal health. The purpose of this study is to examine how various medical specialties collaboratively addressed the complexities of managing a high-risk pregnancy complicated by lupus nephritis. Case Report: Patient diagnosed with lupus nephritis (Stages 4 and 5) and systemic lupus erythematosus (SLE) at age 24 and underwent multiple abdominal surgeries for Mirizzi’s syndrome shortly after her diagnosis. Following recovery, she was initially treated with Plaquenil and steroids. Due to the progression of lupus nephritis and proteinuria, ACE inhibitors, and mycophenolate mofetil (MMF) were added to her treatment. In 2022, patient requested a switch to azathioprine and discontinuation of ACE inhibitors to attempt pregnancy. In 2023, due to a disease flare, she resumed MMF but later transitioned back to azathioprine and amlodipine while attempting conception. By late 2023, her condition stabilized, and a surgical evaluation confirmed minimal adhesions from previous surgeries. As of March 2024, she is pregnant with no flare-ups and has begun Benlysta injections. In June 2024, she required a cervical cerclage. In October 2024, she gave birth to a healthy baby girl. Discussion: The successful management of this pregnancy exemplifies the importance of collaboration. Family Medicine provided care by monitoring the patient’s overall well-being. Rheumatology focused on managing the lupus, ensuring disease stability. Nephrology was critical in overseeing kidney function and addressing proteinuria. Surgical intervention addressed potential adhesions from previous surgeries. Obstetrics and Gynecology managed the pregnancy and performed a cervical cerclage. A multidisciplinary approach is essential for effective disease assessment and planning, especially for high-risk pregnancies. This model involves working closely with patients to make informed decisions, clearly communicating risks, considering fertility preservation, using contraception if needed, systematically assessing risks, managing medications step-by-step, and providing regular monitoring of both maternal and fetal health to ensure a safe and successful pregnancy.