{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T21:51:04Z","timestamp":1792705864142,"version":"4.5.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,6]]},"abstract":"\n Background and objectives<\/jats:title>\n Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis in partial or complete remission, particularly in those with antidouble-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable\/mildly active SLE.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n We assessed active nephritis (renal flares and\n de novo<\/jats:italic>\n kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein \u22641000 mg and serum creatinine <1.2 mg\/dl at baseline; 373 patients (52% ethnic\/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and\/or red blood cell casts.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with\n de novo<\/jats:italic>\n kidney involvement (2%) in 255 patients without past kidney disease (\n P<\/jats:italic>\n <0.001). Active nephritis was not associated with ethnicity, race, age, creatinine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71;\n P<\/jats:italic>\n =0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98;\n P<\/jats:italic>\n <0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares\/\n de novo<\/jats:italic>\n disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13;\n P<\/jats:italic>\n <0.01) but not low C3 or positive anti-dsDNA alone.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n De novo<\/jats:italic>\n kidney involvement in SLE, even in ethnic\/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.11431116","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T20:25:22Z","timestamp":1491942322000},"page":"940-946","source":"Crossref","is-referenced-by-count":79,"title":["Kidney Outcomes and Risk Factors for Nephritis (Flare\/De Novo) in a Multiethnic Cohort of Pregnant Patients with Lupus"],"prefix":"10.2215","volume":"12","author":[{"given":"Jill P.","family":"Buyon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mimi Y.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta M.","family":"Guerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sifan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Reeves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Petri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl A.","family":"Laskin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Lockshin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R.","family":"Sammaritano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. Ware","family":"Branch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. Flint","family":"Porter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allen","family":"Sawitzke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan T.","family":"Merrill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary D.","family":"Stephenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Cohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Salmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,4,11]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1136\/annrheumdis-2012-201940","article-title":"Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR\/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis.","volume":"71","author":"Bertsias","year":"2012","journal-title":"Ann Rheum Dis"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.2215\/CJN.00240110","article-title":"A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis.","volume":"5","author":"Smyth","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1002\/art.20980","article-title":"Relationship between anti-double-stranded DNA antibodies and exacerbation of renal disease in patients with systemic lupus erythematosus.","volume":"52","author":"Linnik","year":"2005","journal-title":"Arthritis Rheum"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1136\/ard.45.5.359","article-title":"Predictive value of complement profiles and anti-dsDNA in systemic lupus erythematosus.","volume":"45","author":"Swaak","year":"1986","journal-title":"Ann Rheum Dis"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s10067-012-1941-4","article-title":"Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy.","volume":"31","author":"Saavedra","year":"2012","journal-title":"Clin Rheumatol"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1093\/rheumatology\/kes425","article-title":"Low risk of renal flares and negative outcomes in women with lupus nephritis conceiving after switching from mycophenolate mofetil to azathioprine.","volume":"52","author":"Fischer-Betz","year":"2013","journal-title":"Rheumatology (Oxford)"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jaut.2016.06.012","article-title":"Maternal outcome in pregnant women with lupus nephritis. A prospective multicenter study.","volume":"74","author":"Moroni","year":"2016","journal-title":"J Autoimmun"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.3899\/jrheum.100997","article-title":"Pregnancy outcomes in systemic lupus erythematosus with and without previous nephritis.","volume":"38","author":"Bramham","year":"2011","journal-title":"J Rheumatol"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"754","DOI":"10.3899\/jrheum.090872","article-title":"The effect of lupus nephritis on pregnancy outcome and fetal and maternal complications.","volume":"37","author":"Gladman","year":"2010","journal-title":"J Rheumatol"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1002\/art.1780400928","article-title":"Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.","volume":"40","author":"Hochberg","year":"1997","journal-title":"Arthritis 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pre-eclampsia.","volume":"117","author":"Lynch","year":"2010","journal-title":"BJOG"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/j.1600-0897.1992.tb00787.x","article-title":"Activation of the complement pathway: Comparison of normal pregnancy, preeclampsia, and systemic lupus erythematosus during pregnancy.","volume":"28","author":"Abramson","year":"1992","journal-title":"Am J Reprod Immunol"},{"key":"B16-20230813","first-page":"97","article-title":"Complement components in normal pregnancy.","volume":"95","author":"Johnson","year":"1987","journal-title":"Acta Pathol Microbiol Immunol Scand C"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/14767050500072722","article-title":"Normal pregnancy is characterized by systemic activation of the complement system.","volume":"17","author":"Richani","year":"2005","journal-title":"J Matern Fetal Neonatal Med"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1093\/ndt\/gfn348","article-title":"Pregnancy in women with pre-existing lupus nephritis: Predictors of fetal and maternal outcome.","volume":"24","author":"Imbasciati","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.3899\/jrheum.100746","article-title":"The clinical utility of measuring complement and anti-dsDNA antibodies during pregnancy in patients with systemic lupus erythematosus.","volume":"38","author":"Clowse","year":"2011","journal-title":"J Rheumatol"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.2215\/CJN.12441211","article-title":"Obstetric nephrology: Lupus and lupus nephritis in pregnancy.","volume":"7","author":"Stanhope","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.ackd.2013.01.012","article-title":"Renal physiology of pregnancy.","volume":"20","author":"Cheung","year":"2013","journal-title":"Adv Chronic Kidney Dis"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1093\/rheumatology\/kev311","article-title":"The frequency and outcome of lupus nephritis: Results from an international inception cohort study.","volume":"55","author":"Hanly","year":"2016","journal-title":"Rheumatology (Oxford)"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/art.38239","article-title":"The incidence and prevalence of systemic lupus erythematosus, 2002-2004: The Georgia Lupus Registry.","volume":"66","author":"Lim","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1002\/art.38238","article-title":"Population-based incidence and prevalence of systemic lupus erythematosus: The Michigan Lupus Epidemiology and Surveillance program.","volume":"66","author":"Somers","year":"2014","journal-title":"Arthritis Rheumatol"}],"container-title":["Clinical Journal of the American Society of 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