Case 051215 "SLE"

"A 29-Year-Old Pregnant Woman with the Nephrotic Syndrome and Hypertension", this CASE RECORD OF THE MASSACHUSETTS GENERAL HOSPITAL describes a 29-year-old pregnant woman with systemic lupus erythematosus who was admitted to the hospital because of renal failure at 20 weeks and 6 days of gestation.
Prior to the visit the patient was been monitored for hypertensive complications of pregnancy or worsening nephritis. Fetal growth was followed with ultrasonography. As she approached the 20th week of pregnancy, marked edema and weight gain occurred, with evidence of worsening renal function. Edema and proteinuria and rising blood pressure were present at the time of admission; this triad is the hallmark of preeclampsia, but each of these findings can also be associated with a flare of lupus nephritis. During the next three weeks, proteinuria persisted, anemia and thrombocytopenia developed and worsened, and the blood pressure continued to rise. A procedure was performed.
In discussing the differential diagnosis, Winfred Williams Jr. writes that the issue is whether she was having a flare of her lupus nephritis, preeclampsia, or both. These two possibilities require radically different management strategies and, therefore, must be sorted out as quickly and efficiently as possible. Williams stresses that this is especially the case in a pregnancy in which renal failure and hypertension are progressing rapidly.