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Lupus Nephritis Pregnancy Planning — ESENeph MCQ

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HardPregnancy & RenalLupus Nephritis Pregnancy PlanningESENeph

A 40-year-old woman has CKD G3a due to lupus nephritis (currently quiescent). She is planning pregnancy and is on Hydroxychloroquine 200 mg BD, Azathioprine 100 mg, and Prednisolone 5 mg. Her eGFR is 55 mL/min/1.73m2 and proteinuria is 0.3 g/day. Regarding pregnancy planning, which statement is correct?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — She should continue all three medications as they are safe in pregnancy; optimise BP and ensure disease remission for at least 6 months before conception

Hydroxychloroquine is safe and should be continued (it reduces flare risk). Azathioprine is safe in pregnancy. Low-dose Prednisolone is safe. Disease remission for at least 6 months before conception is recommended to reduce flare risk. KDIGO 2024 LN guideline and BSR lupus guidelines recommend continuing Hydroxychloroquine throughout pregnancy. Mycophenolate is teratogenic and must NOT be used. eGFR >40 and proteinuria <1 g/day are reasonable pregnancy criteria.

Reference: KDIGO 2024 – Lupus Nephritis; BSR 2018 – SLE in Pregnancy; UKKA 2019 – Pregnancy in CKD