Difficult-to-manage Flare up of Lupus Nephritis during Pregnancy with Confusing Laboratory Findings: A Case Report

Abstract

The inevitable hormonal shifts in the course of pregnancy serve a huge impact on autoimmune disease activity, especially SLE (Systemic Lupus Erythematosus). Although extensively studied in non-pregnant populations, LN (Lupus Nephritis) becomes challenging to diagnose and treat in the context of pregnancy. This case study explores the flare up of LN (Lupus Nephritis) in a 32-year-old Saudi female, who is previously known to have SLE (Systemic Lupus Erythematosus) with a background of biopsy-proven ISN\RPS Class IV LN (Lupus Nephritis) as a consequence that was recently put into remission, yet followed by a relapse upon conception, giving rise to isolated renal disease with strikingly unusual normal numerical values of inflammatory markers, obscuring the clarity of the diagnosis owing to the overlapping with other similar conditions like preeclampsia and deferral of the vital role of renal biopsy for confirmation and monitoring given the patient is in mid-pregnancy (2^nd trimester), forcing the approach to be centered around other alternative parameters and markers rather than invasive monitoring, encouraging a deeper understanding of the nature of these laboratory markers beyond mere results. This patient was successfully managed by steroids course and MMF (Mycophenolate Mofetil) without the need to escalate the immunosuppressive therapy or use potentially teratogenic agents.