Aashi
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A 24-year-old woman with a history of SLE presents to your office in the seventh month of her first pregnancy. She has been having intermittent episodes of headaches associated with some nausea and vomiting over the past week. Her lupus has been well controlled on low-dose prednisone. Her normal blood pressure is 125/80 mm Hg. Her urinalysis and creatinine concentrations were normal at the last visit. Anti-Ro, anti-La, and antiphospholipid antibodies were negative at the onset of her pregnancy. Today her blood pressure is 135/85 mm Hg, with a pulse of 80/min. Her physical examination and fetal monitoring is unremarkable. Today's urinalysis shows proteinuria, erythrocytes, and erythrocyte casts. Her creatinine is 1.7 mg/dL. The complete blood count and liver function tests are normal. Complement levels show low levels of C3 and C4. What would be most appropriate as the next best mode of therapy?
(A) Bedrest
(B) Magnesium sulfate
(C) Cyclophosphamide
(D) Azathioprine
(E) Emergent cesarean section
(F) Methotrexate
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| Guptashutosh
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B MgSO4
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| CocaCola
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????
Seems like she is having an exacerbation of her SLE - glomerulonephritis and low complement levels. she has been taking low dose steroids throughout her pregnancy and should not have a problem with lung maturity. An increase in SLE antibodies may induce heart block in the fetus.
Emergent C-section
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| robin082006
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A
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| sarika
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D) Azathioprine lupus nephritis
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| Aashi
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Answer:
(D) Azathioprine
Explanation:
The patient has lupus nephritis, probably exacerbated by her pregnancy. Pre-eclampsia is a frequent complication of pregnancy in SLE and is seen in the third trimester. It is often difficult to distinguish lupus nephritis from pre-eclampsia. Laboratory testing is often useful with lupus nephritis, which shows proteinuria and an active urine sediment, such as red cells and red cell casts, whereas pre-eclampsia has only proteinuria. Complement levels are low in flares of SLE in comparison with pre-eclampsia, which has normal complement levels. Pre-eclampsia is also associated with thrombocytopenia and elevated liver function tests.
The treatment of pre-eclampsia includes bedrest in mild cases when the diastolic pressure is <105 mm Hg and there is only trace proteinuria. In severe cases, intravenous antihypertensive medications, magnesium sulfate, and emergency caesarian section are indicated. Treatment of active lupus nephritis in pregnancy is dependent on the absence of adverse effects of the medication on the fetus. High-dose prednisone can be used relatively safely. Hydralazine can be used to control the blood pressure. Azathioprine can also be used, with caution, if there is no evidence of leukopenia. Cyclophosphamide and methotrexate are absolutely contraindicated.
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| CocaCola
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Great question Aashi!
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| dr.wad
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yes good one ,
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| prathapdoctor
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good question ashi,thanks a lot,its not even given in harrison regarding the management of SLE in pregnancy indetail.
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