Practical management of lupus nephritis in pregnancy and the puerperium

Pregnancy represents a major challenge in the management of patients with systemic lupus erythematosus, with substantial risks to both mother and baby. Over the past 40 years there have been major improvements in outcomes. This partly relates to the discovery of the antiphospholipid syndrome, which has transformed management of lupus pregnancy, but also due to more effective drugs and better obstetric practice. Despite these advances, significant maternal and fetal morbidity may still occur in patients with lupus nephritis, and there remain ongoing challenges in order to improve outcomes further. In this article we focus on the challenges facing lupus nephritis patients considering pregnancy, and discuss how we approach practical management issues in relation to the current literature.