SUCCESSFUL USE OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN A PREGNANT WOMAN WITH LUPUS NEPHRITIS

Recombinant human erythropoietin (r-HuEPO) is broadly accepted as treatment for anemia in dialysis and nondialysis patients with chronic renal failure, but data regarding the safety and efficacy of this drug in pregnancy are limited. Maternal and fetal problems have been reported to be associated with anemia during pregnancy, On the other hand, anemia is a frequent feature of systemic lupus erythematosus. We report the successful use of r-HuEPO in a young woman with lupus nephritis complicated by severe anemia during pregnancy, Additional studies should be encouraged to confirm the safety of r-HuEPO therapy during pregnancy. (C) 1995 by the National Kidney Foundation, Inc

TUMOR-MARKERS IN PATIENTS UNDERGOING HEMODIALYSIS OR KIDNEY-TRANSPLANTATION

The following tumor markers, AFP, CEA, CA 19-9, CA-125 and CA 15-3 were studied in 50 healthy volunteers (group A), in 23 patients on chronic hemodialysis (group B) and in 30 successfully transplanted individuals (group C) who did not present any clinical symptoms or signs of neoplasia. The levels of AFP, CEA and CA 15-3 were significantly higher in group B when compared to groups A and C. The levels of CA 19-9 and CA-125 did not differ significantly among the three groups. Transplanted individuals (group C) presented significantly lower levels of CEA and AFP and higher levels of CA 15-3 when compared to group B patients. The levels of all markers were not influenced by sex or time on dialysis. It is concluded that: (1) CA 19-9 and CA-125 can be considered as reliable tumor markers in patients undergoing hemodialysis or kidney transplantation. (2) The elevation of CEA and AFP levels in hemodialysis and their decline to normal levels found in the group of successfully transplanted individuals, suggest a possible active role of functioning renal tissue in their clearance. (3) The etiology of CA 15.3 elevation following successful kidney transplantation remains obscure and requires further evaluation

Lupus nephritis and pregnancy

Objective: To record fetal and maternal outcome in pregnancies with systemic lupus nephritis. Subjects: Twelve pregnancies in 11 women with lupus nephritis were studied. All patients were followed during the entire term of the pregnancy and for 6 months postpartum. The laboratory studies performed included antinuclear antibody titer (ANA), anti-DNA antibody titer, complement component levels (C3 and C4), lupus anticoagulant, anticardiolipin antibody, serum creatinine, 24-h urine protein, partial thromboplastin time, VDRL, and tests of hematopoietic and hepatic function. Main Outcome Measures: Antenatal and postnatal complications of lupus nephritis, proteinuria, hypertension, preterm delivery, birthweight, and perinatal mortality. Results: Twenty-five percent of pregnancies resulted in fetal loss, 58% in premature delivery, and 17% in term delivery. There were no neonatal deaths. All patients conceived during a period of clinical remission. Flares of systemic lupus erythematosus (SLE) occurred in four patients. Maternal renal function deteriorated in 25% of the pregnancies but this was reversible in all cases. Increased proteinuria was recorded in 58% of the pregnancies and was irreversible in two women (17%). Hypertension occurred in 42% of the pregnancies, but permanent hypertension postpartum was recorded in only one patient (8%). Conclusions: SLE nephritis remains a high-risk condition for pregnancy. Preeclampsia, prematurity, and fetal growth retardation frequently complicate these pregnancies, and infant morbidity is high. Patients should avoid pregnancy until all manifestations of nephritis are quiescent