Immunosuppression in pregnant women with renal disease: review of the latest evidence in the biologics era.

Journal of Nephrology
Loredana CollaLuigi Biancone

Abstract

Care of pregnant woman, including fertility and procreation counseling, has become a significant part of the nephrological practice in the last years. In this context, the management of immunosuppression assumes a primary role both for autoimmune diseases and for post-transplant follow up. The present review analyzes the latest evidence on immunosuppressive drugs of current use in nephrology and kidney transplantation. Although the placenta inactivates prednisone and prednisolone, it is advisable to limit the dose to the minimal effective one, to prevent side effects. Azathioprine is generally the immunosuppressive of choice in many high-risk pregnancies in autoimmune diseases because of the safety profile and its steroid-sparing property. In lupus nephropathy, hydroxychloroquine is a current indication in the prevention of flares. Cyclosporine and tacrolimus can also be used as steroid-sparing agents as well as in post-transplant maintenance therapy. Experience on mammalian target of rapamycin inhibitors is limited and its use during pregnancy is still controversial even if initial positive data are emerging. Intravenous immunoglobulins are safe and represent an important option for relapses of lupus and vasculitis. Mycophenol...Continue Reading

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Citations

Dec 19, 2018·Journal of Clinical Medicine·Claudio Ponticelli, Gabriella Moroni
Nov 22, 2018·Reproductive Sciences·Sara Z GomesEstela Bevilacqua
Jun 28, 2018·Journal of Nephrology·Gianfranca CabidduUNKNOWN Kidney and Pregnancy Study Group of the Italian Society of Nephrology
Jan 12, 2021·Case Reports in Neurological Medicine·Yazan Al-HasanSaha Kamala

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