Lupus Nephritis and Pregnancy, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes скачать в хорошем качестве

Lupus Nephritis and Pregnancy, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes

A 30-year-old woman with a history of lupus nephritis in sustained remission presents for prenatal care at 10 weeks gestation, reporting no symptoms and demonstrating stable labs. With her current medication regimen and clinical stability, how should her pregnancy be monitored, and what maternal or fetal concerns should clinicians be aware of in this setting? What factors are most crucial in assessing risk and predicting outcomes for this patient? VIDEO INFO Category: Lupus Nephritis and Pregnancy, Lupus Nephritis: Diagnosis and Management, Glomerulonephritis: Causes, Diagnosis, and Management, Nephrology: Kidney Disease Diagnosis and Management Difficulty: Easy - Basic level - Suitable for medical students Question Type: Natural History Case Type: Common Scenario Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 30-year-old woman with SLE and a history of class III lupus nephritis in sustained remission for 18 months presents for routine prenatal care at 10 weeks gestation. She feels well without edema, headache, or visual changes. Vitals: pulse 88/min, temperature 37.1 degreesC, respirations 16/min, blood pressure 110/70 mmHg, oxygen saturation 99% on room air.... OPTIONS A. Live birth is most likely with low renal-flare rates when quiescence is maintained; risk rises late and postpartum, and continuing hydroxychloroquine with low-dose aspirin is recommended. B. Maternal renal failure requiring dialysis occurs in most such pregnancies despite maintained quiescence and ongoing hydroxychloroquine therapy throughout gestation. C. Hydroxychloroquine increases congenital malformation risk, so discontinuation after organogenesis is advisable to reduce fetal exposure during the second and third trimesters. D. Disease quiescence eliminates preeclampsia risk entirely, making low-dose aspirin unnecessary in women with SLE and previous lupus nephritis. CORRECT ANSWER A. Live birth is most likely with low renal-flare rates when quiescence is maintained; risk rises late and postpartum, and continuing hydroxychloroquine with low-dose aspirin is recommended. EXPLANATION In a quiescent SLE pregnancy at 10 weeks with prior class III LN in remission, continuation of hydroxychloroquine and maintenance on azathioprine predict low renal flare rates and favorable obstetric outcomes, particularly when conception follows =6 months of quiescence and aspirin is initiated by 12 weeks. This patient s creatinine is 0.80 mg/dL (eGFR 101.6), UPCR 0.2 g/g, and serologies are stable-features supporting a reassuring trajectory. Flares still cluster late and postpartum; thus surveillance continues even with excellent early status. Incorrect statements include that most such pregnancies progress to dialysis (they do not when quiescence is maintained and HCQ is continued); that hydroxychloroquine increases malformation risk (data support fetal safety and maternal benefit); and that quiescence abolishes preeclampsia risk (SLE and prior LN remain indications for low-dose aspirin). Counseling should emphasize continuation of HCQ, aspirin prophylaxis, and ongoing monitoring of serologies and urine. In summary, the most likely outcome is live birth with low flare rates under continued hydroxychloroquine and aspirin prophylaxis, acknowledging late/postpartum flare vulnerability. Teaching points: Continue hydroxychloroquine during pregnancy. Initiate aspirin by 12-16 weeks in SLE or CKD. Maintain surveillance for late/postpartum flares even in quiescent disease. Further reading: Links to sources are provided for optional further reading only. The questions and explanations are independently authored and do not reproduce or adapt any specific third-party text or content. --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (i.e. Open AI GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this content to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this content as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical