What to Do If You Have Henoch-Schönlein Purpura Nephritis and Are Pregnant
Managing pregnancy when you have a history of Henoch-Schönlein purpura nephritis (HSPN) requires careful medical evaluation and close monitoring. HSPN is an immune-mediated condition that causes inflammation in small blood vessels, particularly affecting the skin, joints, gastrointestinal tract, and kidneys. When it involves the kidneys—known as HSP nephritis—it can lead to long-term renal complications. Pregnancy adds additional physiological stress on the body, especially the kidneys, which must filter waste for both mother and baby. Therefore, understanding your health status before and during pregnancy is crucial.
When Is Pregnancy Considered Safe with HSP Nephritis?
Pregnancy may be possible under specific conditions if you've had HSP nephritis in the past but are now in remission. Women who meet the following criteria might be able to continue their pregnancy with proper supervision:
- No active symptoms of HSP or kidney involvement
- Stable kidney function confirmed by lab tests
- 24-hour urine protein level consistently below 1 gram
- Blood pressure within normal range
Even in these cases, however, the increased metabolic demands of pregnancy—such as higher blood volume, elevated glomerular filtration rate (GFR), and greater nutrient requirements—can strain the kidneys. This added load may trigger a relapse or worsen underlying kidney damage, especially if there's residual scarring from prior inflammation.
Risks During Pregnancy with Kidney Involvement
Women with ongoing or poorly controlled HSP nephritis face significant risks during gestation. As pregnancy progresses, especially in the second and third trimesters, the risk of developing proteinuria exacerbation increases. Elevated protein levels in the urine can signal deteriorating kidney function and may precede more serious complications such as preeclampsia—a dangerous condition characterized by high blood pressure and organ damage, often affecting the liver and kidneys.
Preeclampsia not only threatens maternal health but also impacts fetal development, potentially leading to intrauterine growth restriction (IUGR), preterm birth, or even stillbirth. For this reason, women with any degree of active kidney disease should undergo thorough preconception counseling with a nephrologist and maternal-fetal medicine specialist.
Why Pregnancy Should Be Avoided During Active HSP Nephritis
Active phase of HSP nephritis is a strong contraindication for continuing pregnancy. Signs of active disease include:
- Urinalysis showing significant proteinuria (++ to +++ or higher)
- 24-hour urine protein excretion exceeding 1 gram
- Elevated serum creatinine or blood urea nitrogen (BUN) levels
- Presence of red blood cell casts or hematuria
In such cases, the kidneys are already under severe stress. Adding the hemodynamic changes of pregnancy can accelerate renal decline. Moreover, many immunosuppressive drugs used to treat active HSP nephritis—like cyclophosphamide, mycophenolate mofetil, or certain biologics—are teratogenic and pose serious risks to fetal development.
Recommended Approach: Prioritize Maternal Health
Given the potential dangers, most healthcare providers recommend delaying pregnancy until the disease is in complete remission and kidney function has stabilized for at least 6–12 months. In cases where a woman becomes pregnant during active disease, termination may be advised after a comprehensive risk-benefit analysis involving specialists.
For those planning future pregnancies, achieving durable remission through appropriate treatment, maintaining strict blood pressure control, and adopting a kidney-protective lifestyle (low-salt diet, regular monitoring, avoiding nephrotoxic agents) are essential steps.
Monitoring During Pregnancy: A Multidisciplinary Strategy
If pregnancy is deemed safe and proceeds, frequent surveillance becomes critical. A coordinated care team—including obstetricians, nephrologists, and perinatologists—should manage the patient throughout gestation.
Recommended monitoring includes:
- Monthly or biweekly urinalysis and 24-hour urine protein testing
- Serum creatinine, eGFR, and electrolyte panels every 4–6 weeks
- Blood pressure checks at each prenatal visit
- Fetal ultrasounds to assess growth and amniotic fluid levels
Early detection of worsening kidney function allows timely intervention, possibly including medication adjustments or early delivery if maternal or fetal well-being is compromised.
Conclusion: Safety First for Mother and Baby
While some women with a history of HSP nephritis can have successful pregnancies, the key lies in careful planning, strict monitoring, and individualized medical guidance. The decision to proceed with pregnancy must balance personal desires with realistic assessments of medical risk. With modern prenatal care and multidisciplinary support, many women can navigate this complex journey—but only when their underlying condition is stable and well-managed.