Lupus nephritis mimicking pyelonephritis in pregnancy.
BACKGROUND
Systemic lupus erythematosis (SLE) is a multisystemic autoimmune connective tissue disorder that presents with a wide range of clinical manifestations including renal involvement. Routine prenatal care includes assessment of renal function.


METHODS
A 29-year-old nullipara presented at 17 weeks with fever, vomiting, and costovertebral angle tenderness 1 week after being treated for a presumed urinary tract infection. On presentation, new-onset hypertension was noted. Inpatient evaluation established a diagnosis of SLE with lupus nephritis. The pregnancy ended with intrauterine fetal demise.


CONCLUSIONS
SLE is a disease with complex and protean clinical manifestations. It should appear on the differential when more common disease processes are ruled out. Routine prenatal care can detect otherwise silent and undiagnosed renal disease, and with early intervention improve prognosis.
Friedman
Alexander
A
Department of Obstetrics and Gynecology, Woman & Infants' Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02905, USA. AFriedman@wihri.org
Dailey
Tanya L
TL
Shemin
Douglas
D
Anderson
Brenna L
BL
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005313:Fetal Death; D006801:Humans; D008181:Lupus Nephritis / Q000473:pathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000473:pathology*; D011704:Pyelonephritis / Q000473:pathology*