Pregnancy of a lupus patient--a challenge to the nephrologist.

Systemic lupus erythematosus (SLE) is an autoimmune disease with a predilection for women in their reproductive years. The influence of sex hormones on immunity is only beginning to be unravelled, is fascinating and may explain some of the contradictory reports of the effects of pregnancy on SLE and vice versa [1]. Clinical renal involvement occurs in up to 60–80% of lupus patients at some time point in their disease course. In the pre-steroid era, patients with severe lupus nephritis (LN) rarely survived beyond 2 years. With improved therapy of SLE/LN, survival and quality of life for lupus patients have improved vastly. This holds true even for the Asian region [2,3]. Thus, pregnancy and its outcome are a major concern for most SLE/LN patients and their doctors. Indeed, early reports of pregnancy outcome were quite dismal and underscored active disease at conception, hypertension, proteinuria, moderate renal dysfunction and the antiphospholipid syndrome as major risk factors for pregnancy losses, pregnancy-induced hypertension and pre-eclampsia, progressive renal function deterioration and even the occasional maternal death [1,4–8]. Newer issues relate to neonatal lupus, iatrogenic premature ovarian failure and breast feeding in the presence of immunosuppressive and other drug therapy for control of the underlying SLE/LN. All these complex issues pose a real challenge to the clinician and the nephrologist in particular. Fertility in SLE